AHRQ Patient Safety Culture Surveys:HSOPS, NHSOPS, MOSOPS (Cohort 1)

The AHRQ Safety Program for Improving Antibiotic Use

Documents and Forms

Document Name Document Type
Form 3a2 AHRQ Patient Safety Culture Surveys:HSOPS, NHSOPS, MOSOPS (Cohort 1) Form and Instruction
3a Attachment F: The Hospital Survey on Patient Safety Cult Attachment F HSOPS.1.docx Form and Instruction
3a2 Attachment G: The Nursing Home Survey on Patient Safety Attachment G NHSOPS.1.docx Form and Instruction
3a3 Attachment H: The Medical Office Survey on Patient Safet Attachment H MOSOPS.1.docx Form and Instruction

Information Collection (IC) Details

IC Title:	AHRQ Patient Safety Culture Surveys:HSOPS, NHSOPS, MOSOPS (Cohort 1)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	3a2	Attachment G: The Nursing Home Survey on Patient Safety Culture (NHSOPS)	Attachment G NHSOPS.1.docx	No	Fillable Printable
Form and Instruction	3a3	Attachment H: The Medical Office Survey on Patient Safety Culture (MOSOPS)	Attachment H MOSOPS.1.docx	No	Fillable Printable
Form and Instruction	3a	Attachment F: The Hospital Survey on Patient Safety Culture (HSOPS)	Attachment F HSOPS.1.docx	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 83	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: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	166	166
Annual IC Time Burden (Hours)	83	83
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.