Two Bona Fide Contracts Requirement Form

Patient Safety Organization Certification for Initial Listing and Related Forms, Patient Safety Confidentiality Complaint Form, and Common Formats

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0143 can be found here:

Documents and Forms

Document Name Document Type
Form Form #3 Two Bona Fide Contracts Requirement Form Form and Instruction
Form #3 PSO Two Bona Fide Contracts Requirement Form Attachment.G.PSO_Two Bona Fide Contracts Requirement form_AHRQ.11.2017.docx www.pso.ahrq.gov/forms/contracts Form and Instruction

Information Collection (IC) Details

IC Title:	Two Bona Fide Contracts Requirement Form	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
Form and Instruction	Form #3	PSO Two Bona Fide Contracts Requirement Form	Attachment.G.PSO_Two Bona Fide Contracts Requirement form_AHRQ.11.2017.docx	https://www.pso.ahrq.gov/forms/contracts	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 42	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	42	12	30
Annual IC Time Burden (Hours)	42	12	30
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.