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Federal forms, ICRs, and supporting documents

Information Collection

Attachment B – Safety culture survey_Data collection instrument

IC 227743 under ICR 202009-0935-001 · OMB 0935-0239.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
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Attachment B – Safety culture survey_Data collection instrument
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Attachment B – Safety culture survey_Data collection instrument Attachment B_Safety culture survey_Data collection clean.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,000 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,000 0 -11,000 0 0 12,000
Annual IC Time Burden (Hours) 250 0 -2,750 0 0 3,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment A – Safety culture survey_Cover letter and reminder notice Attachment A_Safety culture survey_Cover letter and reminder notice_20170727.docx 07/28/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.