Information Collection

Attachment Q: Survey of Patient Safety Culture-HSOPS V.2

IC 256469 under ICR 202209-0935-004 · OMB 0935-0260.

Documents and Forms

Document Name Document Type
Form 17 Attachment Q: Survey of Patient Safety Culture-HSOPS V.2 Form and Instruction
17 Attachment Q: Survey of Patient Safety Culture—HSOPS V.2 Att Q SOPS-Hospital-Survey-2.0_6.15.22_mc.pdf Form and Instruction
17 Attachment Q: Survey of Patient Safety Culture—HSOPS V.2 Att Q SOPS-Hospital-Survey-2.0_6.15.22_mc.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment Q: Survey of Patient Safety Culture-HSOPS V.2	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	17	Attachment Q: Survey of Patient Safety CultureâHSOPS V.2	Att Q SOPS-Hospital-Survey-2.0_6.15.22_mc.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,050	1,050
Annual IC Cost Burden (Dollars)	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.