Department of Defense (DoD) Patient Safety Culture Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0720-0034_SS-A_09.28.18.docx	Supporting Statement A	Uploaded 2018-09-28	Available
MTF blurb_survey announcement_Culture of Patient Safety 9.18.18.doc	Supplementary Document	Uploaded 2018-09-28	Available
PS_Live Survey Announcement w Link_March 2018.doc	Supplementary Document	Uploaded 2018-09-28	Available
05NDAA 2001 Sect 754.pdf	Supplementary Document	Uploaded 2018-09-21	Available
FY18 PSafety Spptng Stmt Part B 21Mar18.docx	Supporting Statement B	Uploaded 2018-09-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5614	Department of Defense (DoD) Patient Safety Culture Survey	Other-Questionnaire	Modified

ICR Details

OMB Control No: 0720-0034	ICR Reference No: 201809-0720-002
Status: Active	Previous ICR Reference No: 201507-0720-003
Agency/Subagency: DOD/DODOASHA	Agency Tracking No: 0720-0034
Title: Department of Defense (DoD) Patient Safety Culture Survey
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/03/2018
	Date Received in OIRA: 09/28/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	36 Months From Approved	11/30/2018
Responses	9,200	0	14,022
Time Burden (Hours)	1,533	0	2,337
Cost Burden (Dollars)	64,599	0	64,641

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Abstract: The Department of Defense Patient Safety Culture Survey (PSCS) data collection effort is conducted in response to a task order from the Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense (DoD), and the Defense Health Agency (DHA). Part of the DoD Patient Safety Program’s (PSP’s) mission is to identify and analyze reports on actual and potential problems within the medical systems and processes in each military treatment facility (MTF) within the Military Health System (MHS). In support of its mission, the PSP administers a web-based patient safety culture survey to a census of staff working in Army, Navy, Air Force, and National Capital Region Medical Directorate (NCR) MHS facilities in the Continental United States (CONUS) and internationally (OCONUS) to assess the status of patient safety culture in MHS facilities worldwide.

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Authorizing Statute(s): PL: Pub.L. 106 - 398 754 Name of Law: 2001 National Defense Authorization Act (NDAA)
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 36563	07/30/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 49074	09/28/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Department of Defense (DoD) Patient Safety Culture Survey

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ICR Summary of Burden

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	9,200	14,022	0	-14,022	9,200	0
Annual Time Burden (Hours)	1,533	2,337	0	-2,337	1,533	0
Annual Cost Burden (Dollars)	64,599	64,641	0	-64,641	64,599	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We have reduced the estimated burden based on actual response rates to this survey. The burden estimate has decreased since the previous approval from 2,310 total annual hours to the current requested 1,533 hours. The change of (-777) hours is because the previous estimate was based upon a 60% response rate. The current estimates are based upon the historical 40% response rate.

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Annual Cost to Federal Government: $430,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/28/2018

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