Eligibility/Registration Form and Data Submission

Collection of Information for AHRQ's Hospital Survey on Patient Safety Culture Comparative Database

OMB: 0935-0162

IC ID: 191667

Information Collection (IC) Details

View Information Collection (IC)

Eligibility/Registration Form and Data Submission
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #1 Eligibility and Registration Form Attachment G -- Eligibility and Registration Form.doc Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

304 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 304 0 54 0 0 250
Annual IC Time Burden (Hours) 1,702 0 302 0 0 1,400
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment I -- Emails for Hospital SOPS Data Submission Attachment I -- Emails for Hospital SOPS Data Submission.doc 07/31/2013
Attachment J -- Screen Shots Hospital SOPS Forms Attachment J -- Screen Shots Hospital SOPS Forms.doc 07/31/2013
Attachment K -- HSOPS Survey Data File Specifications Attachment K -- HSOPS Survey Data File Specifications.docx 07/31/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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