Attachment I: Survey of Patient Safety Culture – NHSOPS

The AHRQ Safety Program for Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention

Documents and Forms

Document Name Document Type
Form 2 Attachment I: Survey of Patient Safety Culture – NHSOPS Form and Instruction
2 2,500 Att I NHSOPS.docx Form and Instruction
2 2,500 Att I NHSOPS.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Attachment I: Survey of Patient Safety Culture – NHSOPS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	2	2,500	Att I NHSOPS.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500	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	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	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.