Information Collection

Defense Health Agency Patient Safety Culture Survey

IC 248028 under ICR 202408-0720-001 · OMB 0720-0034.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2024 DoD Patient Safety Culture Survey Instrument_06 20 24.docx	Other-Survey
2024 DoD Patient Safety Culture Survey Instrument_06 20 24.docx	Other-Survey

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Survey			2024 DoD Patient Safety Culture Survey Instrument_06 20 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: 30,965

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30,965	23,145	7,820
Annual IC Time Burden (Hours)	5,161	3,910	1,251
Annual IC Cost Burden (Dollars)	193,944	137,796	56,148

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.