Eligibility Form

Medical Office Survey on Patient Safety Culture Comparative Database

OMB: 0935-0196

IC ID: 201166

Information Collection (IC) Details

View Information Collection (IC)

Eligibility Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Form #1 Medical Office SOPS Database Eligibility Form Attachment A - Medical Office Eligibility and Registration Form.docx Yes Yes Fillable Fileable

Health Immunization Management

 

70 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 70 0 -80 0 0 150
Annual IC Time Burden (Hours) 4 0 -4 0 0 8
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy