Information Collection Request

Pharmacy Survey on Patient Safety Culture Database

ICR 201702-0935-001 · OMB 0935-0218 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 2 Pharmacy SOPS Database Data Use Agreement Form and Instruction Modified Available
Form 3 Pharmacy Background Characteristics Form Form and Instruction Modified Available
Form 1 Pharmacy SOPS Registration Form Form and Instruction Modified Available
Attachment G - Example Screenshots of Pharmacy SOPS Data Submission Web Site_updated 6-13-17_clean.docx Supplementary Document Uploaded 2017-06-20 Available
Attachment F - SOPS Databases TEP List_updated 6-13-17_clean.doc Supplementary Document Uploaded 2017-06-20 Available
Supporting Statement Part B -- Pharm DB Renewal _OMB 6-13-17_clean.doc Supporting Statement B Uploaded 2017-06-20 Available
Supporting Statement Part A -- Pharm DB Renewal_OMB 6-13-17_clean.docx Supporting Statement A Uploaded 2017-06-20 Available
Attachment E - Community Pharmacy Survey Data File Specifications_updated 6-13-17_clean.docx Supplementary Document Uploaded 2017-06-20 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
211073 Data Submission Emails Instruction Modified
211068 Pharmacy SOPS Database Data Use Agreement Form and Instruction Modified
211067 Pharmacy Background Characteristics Form Form and Instruction Modified
211034 Pharmacy SOPS Registration Form Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/29/2020 36 Months From Approved 06/30/2017
600 0 1,950
138 0 296
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 600 1,950 0 -1,350 0 0
Annual Time Burden (Hours) 138 296 0 -158 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No