Information Collection

The Medical Office Survey on Patient Safety Culture (MOSOPS)

IC 258916 under ICR 202407-0935-001 · OMB 0935-0265.

Documents and Forms

Document Name Document Type
Form 3 The Medical Office Survey on Patient Safety Culture (MOSOPS) Form and Instruction
3 Medical Office Survey on Patient Survey Attachment C The Medical Office Survey on Patient Safety Culture (MOSOPS).docx Form and Instruction
3 Medical Office Survey on Patient Survey Attachment C The Medical Office Survey on Patient Safety Culture (MOSOPS).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	The Medical Office Survey on Patient Safety Culture (MOSOPS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	3	Medical Office Survey on Patient Survey	Attachment C The Medical Office Survey on Patient Safety Culture (MOSOPS).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 438	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	876	-990	1,866
Annual IC Time Burden (Hours)	438	-495	933
Annual IC Cost Burden (Dollars)	0	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.