Information Collection Request

Medical Office Survey on Patient Safety Culture Comparative Database

ICR 202409-0935-001 · OMB 0935-0196 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #4 Medical Office SOPS Data Submission Emails Form and Instruction Modified Repair queued
Form Form #3 Medical Office SOPS Data Use Agreement Form and Instruction Modified Repair queued
Form Form #2 Medical Office Site Information Form Form and Instruction Modified Repair queued
Form Form #1 Medical Office Eligibility and Registration Form Form and Instruction Modified Repair queued
Supporting Statement Part A -- 0935-0196 Medical Office SOPS_Extension.docx Supporting Statement A Uploaded 2024-09-26 Repair queued
Attachment F - SOPS Technical Expert Panel (TEP) List.docx Supplementary Document Uploaded 2024-09-26 Repair queued
Attachment E - AHRQ Medical Office SOPS Survey Data File Specifications.pdf Supplementary Document Uploaded 2024-09-26 Missing upstream
Supporting Statement Part B -- 0935-0196 Medical Office SOPS_Extension.docx Supporting Statement B Uploaded 2024-09-26 Repair queued
Attachment G - Example Screenshots of MO SOPS Data Submission Website Information Collection.docx Supplementary Document Uploaded 2024-09-26 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
201169 Medical Office SOPS Data Submission Emails Form and Instruction Modified
201168 Medical Office SOPS Data Use Agreement Form and Instruction Modified
201167 Medical Office Site Information Form Form and Instruction Modified
201166 Medical Office Eligibility and Registration Form Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
6 Months From Approved
2,805 0
306 0
0 0





table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,805 0 0 -425 0 3,230
Annual Time Burden (Hours) 306 0 0 -35 0 341
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No