Data Submission Emails

Pharmacy Survey on Patient Safety Culture Comparative Database

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment D - Emails - Pharmacy SOPS Data Submission.doc		Yes	Yes	Printable Only
Form and Instruction	4	Example Screen Shots of Pharmacy Survey on Patient Safety Culture Data Submission Web Site Information Collection	Attachment J (3).docx		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 %

	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

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.