Attachment H: Survey of Patient Safety Culture – HSOPS

The AHRQ Safety Program for Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention

Documents and Forms

Document Name Document Type
Form 1 Attachment H: Survey of Patient Safety Culture – HSOPS Form and Instruction
1 Attachment H: Survey of Patient Safety Culture – HSOPS Att H HSOPS.docx Form and Instruction
1 Attachment H: Survey of Patient Safety Culture – HSOPS Att H HSOPS.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Attachment H: Survey of Patient Safety Culture – HSOPS	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	1	Attachment H: Survey of Patient Safety Culture – HSOPS	Att H HSOPS.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,667	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,334	-5,000	18,334
Annual IC Time Burden (Hours)	3,334	-1,250	4,584
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.