OMB control number
Pharmacy Survey on Patient Safety Culture Database
OMB 0935-0218 ยท HHS/AHRQ.
OMB 0935-0218
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 2 Pharmacy SOPS Database Data Use Agreement | Form and Instruction |
| Form 3 Pharmacy Background Characteristics Form | Form and Instruction |
| Form 1 Pharmacy SOPS Registration Form | Form and Instruction |
| Attachment G - Example Screenshots of Pharmacy SOPS Data Submission Web Site_updated 6-13-17_clean.docx | Supplementary Document |
 Attachment F - SOPS Databases TEP List_updated 6-13-17_clean.doc | Supplementary Document |
| Supporting Statement Part B -- Pharm DB Renewal _OMB 6-13-17_clean.doc | Supporting Statement B |
| Supporting Statement Part A -- Pharm DB Renewal_OMB 6-13-17_clean.docx | Supporting Statement A |
| Attachment E - Community Pharmacy Survey Data File Specifications_updated 6-13-17_clean.docx | Supplementary Document |
 Data Submission Emails |
Instruction |
| Pharmacy SOPS Database Data Use Agreement |
Form and Instruction |
| Pharmacy Background Characteristics Form |
Form and Instruction |
| Pharmacy SOPS Registration Form |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201702-0935-001 | Discontinue | 2020-02-04 | Approved | |
| 201403-0935-003 | New collection (Request for a new OMB Control Number) | 2014-04-02 | Approved with change |