Pilot test and bridge study

Pilot Test of the Proposed Hospital Survey on Patient Safety Culture Version 2.0

Documents and Forms

Document Name Document Type
Form 3 Pilot test and bridge study Form and Instruction
3 Crosswalk Between the Original AHRQ Hospital Survey on P Attachment A - Crosswalk of Hospital Survey on Patient Saafety 9-2-15.docx Form and Instruction
4 Draft Health IT Patient Safety Attachment B - Draft Health IT and Patient Safety Supplemental Items and Composites 9-2-15 (3).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Pilot test and bridge study	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	3	Crosswalk Between the Original AHRQ Hospital Survey on Patient Safety Culture and Draft Version 2.0	Attachment A - Crosswalk of Hospital Survey on Patient Saafety 9-2-15.docx		Yes	Yes	Fillable Fileable
Form and Instruction	4	Draft Health IT Patient Safety	Attachment B - Draft Health IT and Patient Safety Supplemental Items and Composites 9-2-15 (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: 9,188	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: 90 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,188	9,188
Annual IC Time Burden (Hours)	2,297	2,297
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.