Information Collection

Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan

IC 247238 under ICR 202310-0935-001 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material.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

2025-01-24 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan	Form and Instruction
1 Appendix A: Individual Respondent Characteristics Survey Appendix A_Respondent Characteristics_final.docx	Form and Instruction
1 Appendix A: Individual Respondent Characteristics Survey Appendix A_Respondent Characteristics_final.docx	Form and Instruction
2 Appendix B: Safety Attitude Survey Appendix B_Safety Attitude Survey_final.docx	Form and Instruction
2 Appendix B: Safety Attitude Survey Appendix B_Safety Attitude Survey_final.docx	Form and Instruction
3 Appendix C: Pre-Test Interview Protocol Appendix C_Pre-test Interview Protocol_final.docx	Form and Instruction
3 Appendix C: Pre-Test Interview Protocol Appendix C_Pre-test Interview Protocol_final.docx	Form and Instruction
4 Appendix D: Post-test Evaluation Interview Protocol Appendix D_Post-test Interview Protocol_final.docx	Form and Instruction
4 Appendix D: Post-test Evaluation Interview Protocol Appendix D_Post-test Interview Protocol_final.docx	Form and Instruction
1a Appendix A_Respondent Characteristics_final_6 17 21 Appendix A_Respondent Characteristics_final_6 17 21.docx	Form and Instruction
1a Appendix A_Respondent Characteristics_final_6 17 21 Appendix A_Respondent Characteristics_final_6 17 21.docx	Form and Instruction
3a Appendix C_Pre-test Interview Protocol_final_ 6 17 21 Appendix C_Pre-test Interview Protocol_final_ 6 17 21.docx	Form and Instruction
3a Appendix C_Pre-test Interview Protocol_final_ 6 17 21 Appendix C_Pre-test Interview Protocol_final_ 6 17 21.docx	Form and Instruction
4a Appendix D_Post-test Interview Protocol final 6 17 21 Appendix D_Post-test Interview Protocol final 6 17 21.docx	Form and Instruction
4a Appendix D_Post-test Interview Protocol final 6 17 21 Appendix D_Post-test Interview Protocol final 6 17 21.docx	Form and Instruction
OMB Cover Letter.docx Cover Letter	IC Document
OMB Cover Letter.docx Cover Letter	IC Document
Resoure 5A OMB_Supporting Statement A_final_v2.docx Supporting Statement	IC Document
Resoure 5A OMB_Supporting Statement A_final_v2.docx Supporting Statement	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	1	Appendix A: Individual Respondent Characteristics Survey	Appendix A_Respondent Characteristics_final.docx	No	Paper Only
Form and Instruction	2	Appendix B: Safety Attitude Survey	Appendix B_Safety Attitude Survey_final.docx	No	Paper Only
Form and Instruction	3	Appendix C: Pre-Test Interview Protocol	Appendix C_Pre-test Interview Protocol_final.docx	No	Paper Only
Form and Instruction	4	Appendix D: Post-test Evaluation Interview Protocol	Appendix D_Post-test Interview Protocol_final.docx	No	Paper Only
Form and Instruction	1a	Appendix A_Respondent Characteristics_final_6 17 21	Appendix A_Respondent Characteristics_final_6 17 21.docx	No	Paper Only
Form and Instruction	3a	Appendix C_Pre-test Interview Protocol_final_ 6 17 21	Appendix C_Pre-test Interview Protocol_final_ 6 17 21.docx	No	Paper Only
Form and Instruction	4a	Appendix D_Post-test Interview Protocol final 6 17 21	Appendix D_Post-test Interview Protocol final 6 17 21.docx	No	Paper Only

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: 80

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: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Letter	OMB Cover Letter.docx	05/07/2021
Supporting Statement	Resoure 5A OMB_Supporting Statement A_final_v2.docx	05/07/2021

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