Information Collection

Administration of "Use of Agency for Healthcare Research and Quality (AHRQ) Tools to Measure Aspects of Patient Safety" Questionnaire to AHRQ SOPS® Listserv Subscribers

IC 250572 under ICR 202009-0935-002 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Appendix A Administration of "Use of Agency for Healthcare Research and Quality (AHRQ) Tools to Measure Aspects of Patient Safety" Questionnaire to AHRQ SOPS® Listserv Subscribers	Form and Instruction
Appendix A (Revised).docx	Other-Instrument
1 Appendix A Appendix A.docx	Form and Instruction
OMB Cover Letter.docx Cover Letter	IC Document
Supporting Statement.docx Supporting Statement	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Administration of "Use of Agency for Healthcare Research and Quality (AHRQ) Tools to Measure Aspects of Patient Safety" Questionnaire to AHRQ SOPSÂ® Listserv Subscribers

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1				Yes	Yes	Fillable Fileable
Other-Instrument					Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	133	133
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Letter		11/29/2021
Supporting Statement		11/29/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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