Pilot Test of the Proposed Diagnostic Safety Supplemental Item Set for the Medical Office Survey on Patient Safety Culture

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

OMB: 0935-0124

IC ID: 235839

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Pilot Test of the Proposed Diagnostic Safety Supplemental Item Set for the Medical Office Survey on Patient Safety Culture
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Attachment B: Draft Diagnostic Safety Cognitive Interview Guide Attachment B - Diagnostic Safety Cog Interview Guide 3-26-19.docx Yes Yes Fillable Fileable
Form and Instruction 2 Medical office information survey Attachment C - Medical office information form_site-level data file specs.docx Yes Yes Fillable Fileable
Form and Instruction 3 Pilot test Attachment A - Draft Diagnostic Safety Supplemental Item Set 3-13-19.docx Yes Yes Fillable Fileable
Form and Instruction 4 Attachment A - Draft Diagnostic Safety Supplemental Item Set 7-3-19.docx Attachment A - Draft Diagnostic Safety Supplemental Item Set 7-3-19.docx Yes Yes Fillable Fileable
Form and Instruction 5 Attachment B - Diagnostic Safety Cog Interview Guide 7-3-19.docx Attachment B - Diagnostic Safety Cog Interview Guide 7-3-19.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,545 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 1,545 0 1,545 0 0 0
Annual IC Time Burden (Hours) 538 0 538 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letter OMB Cover Letter.docx.doc 05/03/2019
Attachment C1: Medical Office Point of Contact (POC) Instructions Attachment C 1 - Medical Office Point of Contact (POC) Instructions 3-13-19.docx 05/03/2019
Attachment D: Survey Invitation and Reminder Notices Attachment D - Survey Invitation and Reminder Notices 3-13-19.docx 05/03/2019
Attachment E: Federal Register Notice Attachment E -- 60 Day FRN.pdf 05/03/2019
Attachment F: Technical Expert Panel Members Attachment F - Diagnostic Safety TEP List 3-13-19.docx 05/03/2019
Supporting Statement A Supporting Statement Part A - Pilot Test of SOPS Dx Safety - 4-9-2019 (003).docx 05/03/2019
Supporting Statement Part B Supporting Statement Part B - Pilot Test of SOPS Dx Safety - 3-26-2019.docx 05/03/2019
Supporting Statement A Supporting Statement Part A - Pilot Test of SOPS Dx Safety - 7-18-2019.docx 08/07/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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