Attachment H_PSO Change of Listing Information

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

OMB: 0935-0143

IC ID: 213835

Information Collection (IC) Details

View Information Collection (IC)

Attachment H_PSO Change of Listing Information
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form 6 PSO Change of Listing Information Attachment H_DRAFT_PSO Change of Listing Information Form.docx Yes Yes Fillable Fileable

Health Health Care Services

 

51 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 51 0 -3 0 54 0
Annual IC Time Burden (Hours) 4 0 -1 0 5 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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