Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Cognitive Testing of the Medical Expenditure Panel Survey (MEPS) Health Insurance Verification Module New 444 77 0 Form and Instruction B1 Attachment B – Screening Questionnaire
Form and Instruction C1 Attachment C1 - Cognitive Interview Guide and Questionnaire
Environmental Scan for Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families New 48 43 0 Form and Instruction 2 Attachment B: Key Informant Interview Guide- In-person
Form and Instruction 4 Attachment D: Interview Guide for Case Study Development- In-person
Form and Instruction 6 Attachment F: Interview Guide for Patients/Family Members/Caregivers- In-person
Form and Instruction 8 Attachment H: Interview Guide for Primary Care Practice Staff and Physicians- In-person
Form and Instruction 1 Attachment A: Key Informant Interview Guide- Telephone
Form and Instruction 3 Attachment C: Interview Guide for Case Study Development- Telephone
Form and Instruction 5 Attachment E: Interview Guide for Patients/Family Members/Caregivers- Telephone
Form and Instruction 7 Attachment G: Interview Guide for Primary Care Practice Staff and Physicians- Telephone
Identifying, Assessing, and Balancing Competing Risks of Multiple Hospital-Acquired Conditions (HACs) New 24 36 0 Form and Instruction 2 Attachment B – HAC Risk Dashboard Tool Low-Fidelity Prototype Evaluation Focus Group Guide
Identifying, Assessing, and Balancing Competing Risks of Multiple Hospital-Acquired Conditions (HACs) New 28 28 0 Form and Instruction 3 Attachment C – HAC Risk Dashboard Tool Key Informant Interview Guide
Identifying, Assessing, and Balancing Competing Risks of Multiple Hospital-Acquired Conditions (HACs) New 24 36 0 Form and Instruction 1 Attachment A – HAC Risk Dashboard Tool Information Needs Identification Focus Group Guide
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 568 220 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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