Information Collection

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

IC 227703 under ICR 201906-0935-002 · OMB 0935-0238.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.