Staff survey

Development of the Guide to Patient and Family Engagement in Health Care Quality and Safety in the Hospital Setting

Documents and Forms

Document Name Document Type
Form Form #10 Staff survey Form and Instruction
Form #10 Staff Survey Attachment O -- Staff Survey_070110.doc Form and Instruction
Attachment P -- Invitation to Participate in Staff Survey 020411.doc Attachment P -- Invitation to Participate in Staff Survey 020411 IC Document

Information Collection (IC) Details

IC Title:	Staff survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #10	Staff Survey	Attachment O -- Staff Survey_070110.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment P -- Invitation to Participate in Staff Survey 020411	Attachment P -- Invitation to Participate in Staff Survey 020411.doc	02/10/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.