Information Collection

57.132 - Patient Safety Digital Reporting Plan (RPS CSV)

IC 263449 under ICR 202603-0920-006 · OMB 0920-0666.

Documents and Forms

Document Name Document Type
Form 57.132 Patient Safety Digital Reporting Plan (RPS CSV) 57.132 - Patient Safety Digital Reporting Plan (RPS CSV) Form and Instruction
57.132 Patient Safety Digital Reporting Plan (RPS CSV) 57.132 RPS Data Table csv Clean Version.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.132 - Patient Safety Digital Reporting Plan (RPS CSV)	Agency IC Tracking Number:	0920-0666

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	57.132	Patient Safety Digital Reporting Plan (RPS CSV)	57.132 RPS Data Table csv Clean Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,125	-1,998,375	2,007,500
Annual IC Time Burden (Hours)	304	-66,613	66,917
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.

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