Department of Defense (DoD) Patient Safety Culture Survey

ICR 201809-0720-002

OMB: 0720-0034

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2018-09-28
Supplementary Document
2018-09-28
Supplementary Document
2018-09-28
Supplementary Document
2018-09-21
Supporting Statement B
2018-09-21
IC Document Collections
ICR Details
0720-0034 201809-0720-002
Active 201507-0720-003
DOD/DODOASHA 0720-0034
Department of Defense (DoD) Patient Safety Culture Survey
Extension without change of a currently approved collection   No
Regular
Approved without change 12/03/2018
Retrieve Notice of Action (NOA) 09/28/2018
  Inventory as of this Action Requested Previously Approved
12/31/2021 36 Months From Approved 11/30/2018
9,200 0 14,022
1,533 0 2,337
64,599 0 64,641

The Department of Defense Patient Safety Culture Survey (PSCS) data collection effort is conducted in response to a task order from the Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense (DoD), and the Defense Health Agency (DHA). Part of the DoD Patient Safety Program’s (PSP’s) mission is to identify and analyze reports on actual and potential problems within the medical systems and processes in each military treatment facility (MTF) within the Military Health System (MHS). In support of its mission, the PSP administers a web-based patient safety culture survey to a census of staff working in Army, Navy, Air Force, and National Capital Region Medical Directorate (NCR) MHS facilities in the Continental United States (CONUS) and internationally (OCONUS) to assess the status of patient safety culture in MHS facilities worldwide.

PL: Pub.L. 106 - 398 754 Name of Law: 2001 National Defense Authorization Act (NDAA)
  
None

Not associated with rulemaking

  83 FR 36563 07/30/2018
83 FR 49074 09/28/2018
No

1
IC Title Form No. Form Name
Department of Defense (DoD) Patient Safety Culture Survey

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 9,200 14,022 0 -14,022 9,200 0
Annual Time Burden (Hours) 1,533 2,337 0 -2,337 1,533 0
Annual Cost Burden (Dollars) 64,599 64,641 0 -64,641 64,599 0
No
Yes
Miscellaneous Actions
We have reduced the estimated burden based on actual response rates to this survey. The burden estimate has decreased since the previous approval from 2,310 total annual hours to the current requested 1,533 hours. The change of (-777) hours is because the previous estimate was based upon a 60% response rate. The current estimates are based upon the historical 40% response rate.

$430,000
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Kira Starks 571 372-4529 danikquia.k.starks.ctr@mail.mil

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/28/2018


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