Defense Health Agency Patient Safety Culture Survey

Documents and Forms

Document Name Document Type
2024 DoD Patient Safety Culture Survey Instrument_06 20 24.docx Other-Survey
2024 DoD Patient Safety Culture Survey Instrument_06 20 24.docx Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Defense Health Agency Patient Safety Culture Survey	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
Other-Survey			2024 DoD Patient Safety Culture Survey Instrument_06 20 24.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,965	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30,965	23,145	7,820
Annual IC Time Burden (Hours)	5,161	3,910	1,251
Annual IC Cost Burden (Dollars)	193,944	137,796	56,148

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.