Department of Defense (DoD) Patient Safety Culture Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0034 can be found here:

Documents and Forms

Document Name Document Type
0720-0034-2022 MHS Survey on Patient Safety Culture for OMB 4.15.2021.docx Other-Survey
0720-0034-2022 MHS Survey on Patient Safety Culture for OMB 4.15.2021.docx Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Department of Defense (DoD) Patient Safety Culture Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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			0720-0034-2022 MHS Survey on Patient Safety Culture for OMB 4.15.2021.docx		Yes	Yes	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,820	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,820	7,820
Annual IC Time Burden (Hours)	1,251	1,251
Annual IC Cost Burden (Dollars)	56,148	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.