Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Advancing the Collection and Use of Patient –Reported Outcomes through Health Information Technology New 899 120 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Cognitive Testing of the Medical Expenditure Panel Survey (MEPS) Health Insurance Verification Module Removed 0 0 0 Form and Instruction B1
Form and Instruction C1
Environmental Scan for Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families Removed 0 0 0 Form and Instruction 2
Form and Instruction 4
Form and Instruction 6
Form and Instruction 8
Form and Instruction 1
Form and Instruction 3
Form and Instruction 5
Form and Instruction 7
Field Test of Low Literacy Version of CAHPS Clinician and Group Survey New 800 92 0 Form and Instruction 1
Form and Instruction 2
Field Test of SPPC-II Toolkit and Training Modules during Pilot Phase of SPPC-II Demonstration Project New 32 17 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 1
Form and Instruction 2
Identifying, Assessing, and Balancing Competing Risks of Multiple Hospital-Acquired Conditions (HACs) Removed 0 0 0 Form and Instruction 2
Identifying, Assessing, and Balancing Competing Risks of Multiple Hospital-Acquired Conditions (HACs) Removed 0 0 0 Form and Instruction 1
Identifying, Assessing, and Balancing Competing Risks of Multiple Hospital-Acquired Conditions (HACs) Removed 0 0 0 Form and Instruction 3
Implementation of an Electronic Care Plan for People with Multiple Chronic Conditions New 34 34 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Pilot Test of the Proposed Diagnostic Safety Supplemental Item Set for the Medical Office Survey on Patient Safety Culture New 1545 538 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Form and Instruction 4
Form and Instruction 5
Pilot Test of the Proposed Workforce Safety Supplemental Item Set For the Surveys on Patient Safety Culture New 5782 1935 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Pilot Test of the Protocol for Eliciting Patient Narratives from Parents for the Child Hospital Consumer Assessment of Healthcare New 100 75 0 Form and Instruction 1
Form and Instruction 2
Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality - Insurance Plans Purchased Individually New 245 28 0 Form and Instruction 3
Form and Instruction 1
Form and Instruction 2
Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality – Marketplaces and Exchanges New 245 28 0 Form and Instruction 3
Form and Instruction 1
Form and Instruction 2
Testing for Potential Enhancements to the Medical Expenditure Panel Survey: Study on Employer-sponsored Insurance Plans New 310 45 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Form and Instruction 4
Testing for Potential Enhancements to the Medical Expenditure Panel Survey: Study on Insurance Plans offered by Local Governments New 240 23 0 Form and Instruction 3
Form and Instruction 1
Form and Instruction 2
Testing for Potential Enhancements to the Medical Expenditure Panel Survey: Study on Insurance Plans offered by State Governments New 240 23 0 Form and Instruction 3
Form and Instruction 1
Form and Instruction 2
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 10472 2958 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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