3. AHRQ Patient Safety Culture Surveys:d. MOSOPS (Cohort 4)

The AHRQ Safety Program for Improving Antibiotic Use

Documents and Forms

Document Name Document Type
Form 3d 3. AHRQ Patient Safety Culture Surveys:d. MOSOPS (Cohort 4) Form and Instruction
3d Attachment H: The Medical Office Survey on Patient Safet Attachment H MOSOPS.1.docx Form and Instruction

Information Collection (IC) Details

IC Title:	3. AHRQ Patient Safety Culture Surveys:d. MOSOPS (Cohort 4)	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3d	Attachment H: The Medical Office Survey on Patient Safety Culture (MOSOPS)	Attachment H MOSOPS.1.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,167	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,334	4,167	4,167
Annual IC Time Burden (Hours)	4,167	2,083	2,084
Annual IC Cost Burden (Dollars)	0	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.