Medical Office Survey on Patient Safety Culture Comparative Database

ICR 202504-0935-001

OMB: 0935-0196

Federal Form Document

Forms and Documents

Document Name	Status
Form Form #4 Medical Office SOPS Data Submission Emails Form and Instruction	Unchanged
Form Form #3 Medical Office SOPS Data Use Agreement Form and Instruction	Unchanged
Form Form #2 Medical Office Site Information Form Form and Instruction	Unchanged
Form Form #1 Medical Office Eligibility and Registration Form Form and Instruction	Unchanged
Supporting Statement Part B -- 0935-0196 Medical Office SOPS_Extension.docx Supporting Statement B	2025-04-07
Supporting Statement Part A -- 0935-0196 Medical Office SOPS_Extension.docx Supporting Statement A	2025-04-07
Attachment F - SOPS Technical Expert Panel (TEP) List.docx Supplementary Document	2024-09-26
Attachment E - AHRQ Medical Office SOPS Survey Data File Specifications.pdf Supplementary Document	2024-09-26
Attachment G - Example Screenshots of MO SOPS Data Submission Website Information Collection.docx Supplementary Document	2024-09-26

IC Document Collections

IC ID	Document Title	Status
201169	Medical Office SOPS Data Submission Emails Form and Instruction	Unchanged
201168	Medical Office SOPS Data Use Agreement Form and Instruction	Unchanged
201167	Medical Office Site Information Form Form and Instruction	Unchanged
201166	Medical Office Eligibility and Registration Form Form and Instruction	Unchanged