Information Collection Request

AHRQ Safety Program for Improving Surgical Care and Recovery

ICR 202009-0935-001 · OMB 0935-0239 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 5 Attachment J – Data collection instrument: Site Visit Assessment Form and Instruction Unchanged Repair queued
Form 3 Readiness and Implementation assessment Form and Instruction Unchanged Repair queued
Form 2 Attachment D – Patient Experience Survey_Data collection instrument Form and Instruction Unchanged Repair queued
Form 1 Attachment B – Safety culture survey_Data collection instrument Form and Instruction Unchanged Repair queued
Supporting Statement Part B.docx Supporting Statement B Uploaded 2020-09-28 Repair queued
Supporting Statement Part A clean 09112020.docx Supporting Statement A Uploaded 2020-09-28 Repair queued
Attachment K_Program list of experts_20170727.docx Supplementary Document Uploaded 2017-07-28 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
227747 Attachment J – Data collection instrument: Site Visit Assessment Form and Instruction Unchanged
227746 Readiness and Implementation assessment Form and Instruction Unchanged
227745 Attachment D – Patient Experience Survey_Data collection instrument Form and Instruction Unchanged
227743 Attachment B – Safety culture survey_Data collection instrument Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 01/31/2021
14,560 14,560
4,706 4,706
0 0





table that charts list of burden
  Total Request 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 14,560 14,560 0 0 0 0
Annual Time Burden (Hours) 4,706 4,706 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No