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Data Submission Emails
Pharmacy Survey on Patient Safety Culture Database
OMB: 0935-0218
IC ID: 211073
OMB.report
HHS/AHRQ
OMB 0935-0218
ICR 201702-0935-001
IC 211073
( )
Documents and Forms
Document Name
Document Type
Attachment D - Pharmacy Data Submission Emails_updated 6-13-17_clean.docx
Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Data Submission Emails
Agency IC Tracking Number:
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
Instruction
Attachment D - Pharmacy Data Submission Emails_updated 6-13-17_clean.docx
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
100
0
-50
0
0
150
Annual IC Time Burden (Hours)
100
0
-50
0
0
150
Annual IC Cost Burden (Dollars)
0
0
0
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.