Attachment D- Data File Emails

Collection of Information for AHRQ's Hospital Survey on Patient Safety Culture Comparative Database

Documents and Forms

Document Name Document Type
Form 4 Attachment D- Data File Emails Form and Instruction
4 Data Submission Emails Attachment D - Data Submission Emails - 1-5-2026.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Attachment D- Data File Emails	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
Form and Instruction	4	Data Submission Emails	Attachment D - Data Submission Emails - 1-5-2026.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 165	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 %

	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	165	0	165
Annual IC Time Burden (Hours)	165	0	165
Annual IC Cost Burden (Dollars)	23,694	-270	23,964

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.