13. Omnibus Safety and Culture Survey

Implementation and Testing of Diagnostic Safety Resources

Documents and Forms

Document Name Document Type
Form 13a 13. Omnibus Safety and Culture Survey Form and Instruction
13a Omnibus Survey of Diagnostic Safety Culture: Medical Off Attachment N - Omnibus Safety and Culture Survey_ Medical Offices.2024_5_24.docx Form and Instruction
13a Omnibus Survey of Diagnostic Safety Culture: Medical Off Attachment N - Omnibus Safety and Culture Survey_ Medical Offices.2024_5_24.docx Form and Instruction
13b Omnibus Survey of Diagnostic Safety Culture: Hospitals Attachment O - Omnibus Safety and Culture Survey_Hospitals.2024_5_24.docx Form and Instruction
13b Omnibus Survey of Diagnostic Safety Culture: Hospitals Attachment O - Omnibus Safety and Culture Survey_Hospitals.2024_5_24.docx Form and Instruction

Information Collection (IC) Details

IC Title:	13. Omnibus Safety and Culture Survey	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	13a	Omnibus Survey of Diagnostic Safety Culture: Medical Offices	Attachment N - Omnibus Safety and Culture Survey_ Medical Offices.2024_5_24.docx		Yes	Yes	Fillable Fileable
Form and Instruction	13b	Omnibus Survey of Diagnostic Safety Culture: Hospitals	Attachment O - Omnibus Safety and Culture Survey_Hospitals.2024_5_24.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: 329	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	987	987
Annual IC Time Burden (Hours)	329	329
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.