Information Collection

The Medical Office Survey on Patient Safety Culture (MOSOPS)

IC 258916 under ICR 202303-0935-001 · OMB 0935-0265.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0265 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 The Medical Office Survey on Patient Safety Culture (MOSOPS)	Form and Instruction
4 Attachment D: The Medical Office Survey on Patient Safet Att D_The Medical Office Survey on Patient Safety Culture (MOSOPS).docx	Form and Instruction
4 Attachment D: The Medical Office Survey on Patient Safet Att D_The Medical Office Survey on Patient Safety Culture (MOSOPS).docx	Form and Instruction

IC Title:

The Medical Office Survey on Patient Safety Culture (MOSOPS)

Agency IC Tracking Number:

Is this a Common Form? No

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	4	Attachment D: The Medical Office Survey on Patient Safety Culture (MOSOPS)	Att D_The Medical Office Survey on Patient Safety Culture (MOSOPS).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 933

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	1,866	1,866
Annual IC Time Burden (Hours)	933	933
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.