Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Feasibility Study for a MEPS Monthly Check-In New 195 90 0 Form and Instruction 1B Attachment 1-B. Study 1 Recruitment screener
Form and Instruction 1C Attachment 1-B. Study 1 Recruitment screener
Form and Instruction 1F Attachment 1-F. Study 1 MCI Protocol 1
Form and Instruction 1G Attachment 1-G. Study 1 MCI Protocol 2
Form and Instruction 1H Attachment 1-H. Study 1 Protocol 3 (R2)
Form and Instruction 1I Attachment 1-I. Study 1 MEPS Abbreviated R2 Interview
Form and Instruction 2B Attachment 2-B. Study 2 Recruitment telephone script + scheduling MCI interview
Form and Instruction 2E Attachment 2-E. Study 2 MCI Protocol
Instruction
Instruction
Field Test of A Survey of End-of-Life Care New 510 97 0 Form and Instruction 1 Survey of End-of-Life Care
MEPS Alternative Sampling Design Pilot Test New 3393 567 0 Form and Instruction 1 Pilot Screener
Patient and Caregiver Survey New 90 90 0 Form and Instruction 1 Patient and Caregiver Survey
Patient and Caregiver Usability Interview New 10 10 0 Form and Instruction 1 Patient and Caregiver Usability Interview
Pilot Test of the Proposed Workplace Safety Supplemental Item Set For the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey New 4309 1432 0 Form and Instruction 1 Attachment B: Draft Workplace Safety Cognitive Interview Guide
Form and Instruction 2 Attachment C: Nursing Home Point of Contact (POC) Instructions
Form and Instruction 3 Attachment A: Draft Workplace Safety Supplemental Item Set
Form and Instruction Attachment F Nursing Home Background Information Form
Pilot Test of the Revised Data Collection Method for the Medical Expenditure Panel Survey - Insurance Component New 3000 1180 0 Form and Instruction 1 Pilot test – Establishment Questionnaire
Form and Instruction 2 Pilot test – Plan Questionnaire
Provider Focus Group New 20 30 0 Form and Instruction 1 Provider Focus Group
Provider and Patient Interview New 13 13 0 Form and Instruction 1 Provider and Patient Interview
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 11540 3509 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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