Information Collection

Data Submission Emails

IC 211073 under ICR 201403-0935-003 · OMB 0935-0218.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0218 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Example Screen Shots of Pharmacy Survey on Patient Safety Culture Data Submission Web Site Information Collection Data Submission Emails	Form and Instruction
Attachment D - Emails - Pharmacy SOPS Data Submission.doc	Instruction
4 Example Screen Shots of Pharmacy Survey on Patient Safet Attachment J (3).docx	Form and Instruction

IC Title:

Data Submission Emails

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction					Yes	Yes	Printable Only
Form and Instruction	4				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].