Nursing Home Survey on Patient Safety Culture Comparative Database

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form 1 Nursing Home Eligibility and Registration Form	Form and Instruction	Modified	Repair queued
Form Form 1 Nursing Home Eligibility and Registration Form	Form and Instruction	Modified	Repair queued
Form Form 4 Nursing Home SOPS Data File Submission	Form and Instruction	Modified	Available
Form Form 4 Nursing Home SOPS Data File Submission	Form and Instruction	Modified	Repair queued
Form Form 3 Nursing Home Site Information Form	Form and Instruction	Modified	Available
Form Form 3 Nursing Home Site Information Form	Form and Instruction	Modified	Repair queued
Form Form 2 SOPS Nursing Home Database Data Use Agreement	Form and Instruction	Modified	Available
Form Form 2 SOPS Nursing Home Database Data Use Agreement	Form and Instruction	Modified	Repair queued
Attachment G - Example Screenshots of NH SOPS Data Submission Web Site Information Collection.docx	Supplementary Document	Uploaded 2024-10-11	Available
Attachment G - Example Screenshots of NH SOPS Data Submission Web Site Information Collection.docx	Supplementary Document	Uploaded 2024-10-11	Repair queued
Attachment F - SOPS Databases TEP List.docx	Supplementary Document	Uploaded 2024-10-11	Available
Attachment F - SOPS Databases TEP List.docx	Supplementary Document	Uploaded 2024-10-11	Repair queued
Attachment E - Nursing Home Survey Data File Specifications.docx	Supplementary Document	Uploaded 2024-10-11	Repair queued
Attachment E - Nursing Home Survey Data File Specifications.docx	Supplementary Document	Uploaded 2024-10-11	Repair queued
Supporting Statement Part B_NHSOPS Renewal_3-14-24.docx	Supporting Statement B	Uploaded 2025-03-06	Repair queued
Supporting Statement Part B_NHSOPS extension wochange_10.10.24.docx	Supporting Statement B	Uploaded 2024-10-11	Repair queued
OMB Passback_Jan 16 24_Supporting Statement Part A_NHSOPS extension wochange_CLEAN.docx	Supporting Statement A	Uploaded 2025-03-06	Repair queued
Supporting Statement Part A_NHSOPS extension wochange_10.10.24.docx	Supporting Statement A	Uploaded 2024-10-11	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217465	Nursing Home Eligibility and Registration Form	Form and Instruction	Modified	Nursing Home Eligibility and Registration Form
217465	Nursing Home Eligibility and Registration Form	Form and Instruction	Modified
201035	Nursing Home SOPS Data File Submission	Form and Instruction	Modified	Nursing Home SOPS Data File Submission
201035	Nursing Home SOPS Data File Submission	Form and Instruction	Modified
201034	Nursing Home Site Information Form	Form and Instruction	Modified	Nursing Home Site Information Form
201034	Nursing Home Site Information Form	Form and Instruction	Modified
201033	SOPS Nursing Home Database Data Use Agreement	Form and Instruction	Modified	SOPS Nursing Home Database Data Use Agreement
201033	SOPS Nursing Home Database Data Use Agreement	Form and Instruction	Modified

ICR Details

OMB Control No: 0935-0195	ICR Reference No: 202410-0935-001
Status: Active	Previous ICR Reference No: 202109-0935-002
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Nursing Home Survey on Patient Safety Culture Comparative Database
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/10/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/15/2024
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2028	36 Months From Approved	03/31/2025
Responses	400	0	320
Time Burden (Hours)	77	0	61
Cost Burden (Dollars)	0	0	0

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Abstract: In 1999, the Institute of Medicine called for health care organizations to develop a "culture of safety" such that their workforce and processes focus on improving the reliability and safety of care for patients (IOM, 1999; "To Err is Human: Building a Safer Health System"). To respond to the need for tools to assess patient safety culture in health care, AHRQ developed and pilot tested the Nursing Home Survey on Patient Safety Culture with OMB approval (OMB NO. 0935-0132; Approved July 5, 2007). The survey is designed to enable nursing homes to assess provider and staff opinions about patient safety issues, medical error, and error reporting and includes 42 items that measure 12 dimensions of patient safety culture. AHRQ made the survey publicly available along with a Survey User's Guide and other toolkit materials in November 2008 on the AHRQ Web site (located at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/nursing-home/index.html). The AHRQ Nursing Home SOPS Comparative Database consists of data from the AHRQ Nursing Home Survey on Patient Safety Culture. Nursing homes in the U.S. are asked to voluntarily submit data from the survey to AHRQ through its contractor, Westat. The Nursing Home SOPS database (OMB NO. 0935-0195, last approved on October 26, 2021) was developed by AHRQ in 2011 in response to requests from nursing homes interested in knowing how their patient safety culture survey results compare to those of other nursing homes in their efforts to improve patient safety. The survey and database have the following goals: 1) Promote improvements in the quality and safety of healthcare in nursing home settings, 2) Present results from nursing homes that voluntarily submit their data, 3) Provide data to nursing homes to facilitate internal assessment and learning in the patient safety improvement process, and 4) Provide supplemental information to help nursing homes identify their strengths and areas with potential for improvement in patient safety culture.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 65350	08/09/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 82243	10/10/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Nursing Home Eligibility and Registration Form	Form 1	Nursing Home Eligibility and Registration Form
Nursing Home SOPS Data File Submission	Form 4	Nursing Home SOPS Data File Submission
Nursing Home Site Information Form	Form 3	Nursing Home Site Information Form
SOPS Nursing Home Database Data Use Agreement	Form 2	SOPS Nursing Home Database Data Use Agreement

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	400	320	0	80	0	0
Annual Time Burden (Hours)	77	61	0	16	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The estimated number of POCs decreased from 60 in the previous information collection request (ICR) to 50 in this ICR. This updated estimate is based upon the actual number of POCs in the 2022 SOPS Nursing Home data submission. As a result of fewer POCs submitting data, the total burden hours decreased from 91 to 60.

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Annual Cost to Federal Government: $200,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/15/2024

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