Information Collection

– Draft Health IT Patient Safety Supplemental Item Set Cognitive Interview Guide

IC 218049 under ICR 201508-0935-001 · OMB 0935-0230.

Documents and Forms

Document Name Document Type
Form 2 – Draft Health IT Patient Safety Supplemental Item Set Cognitive Interview Guide Form and Instruction
2 – Draft Health IT Patient Safety Supplemental Item Set C Attachment D - Health IT Cog Interview Guide 3-20-15.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	â Draft Health IT Patient Safety Supplemental Item Set Cognitive Interview Guide	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	2	â Draft Health IT Patient Safety Supplemental Item Set Cognitive Interview Guide	Attachment D - Health IT Cog Interview Guide 3-20-15.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	36	36
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.