Form # 1 Form # 1 Attachment A: Hospital Eligibility and Registration Form

Collection of Information for AHRQ's Hospital Survey on Patient Safety Culture Comparative Database

Attachment A - Eligibility and Registration Form - 3-1-22

Eligibility/Registration Form and Data Submission

OMB: 0935-0162

Document [docx]
Download: docx | pdf

Shape2

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX



AHRQ Hospital Survey on Patient Safety Culture Database, Supporting Statement A

Attachment A: Eligibility and Registration Form







Shape1

Public reporting burden for this collection of information is estimated to average 3 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 5600 Fishers Lane, Rockville, MD 20857.


















File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorTheresa Famolaro
File Modified0000-00-00
File Created2022-09-14

© 2024 OMB.report | Privacy Policy