Information Collection

13. Omnibus Safety and Culture Survey

IC 268501 under ICR 202406-0935-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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	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 %

table that charts list of burden
	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

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.