Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
AHRQ.gov Taxonomy Tree Test Unchanged 800 200 0 Form and Instruction 1 AHRQ.gov Taxonomy Tree Test
Administration of "Use of Agency for Healthcare Research and Quality (AHRQ) Tools to Measure Aspects of Patient Safety" Questionnaire to AHRQ SOPS® Listserv Subscribers Unchanged 1000 133 0 Form and Instruction 1 Appendix A
Other-Instrument
Agency for Healthcare Research and Quality (AHRQ) COVID-19 Primary Care Learning Community Participant Survey Unchanged 285 24 0 Form and Instruction 1 PCLC Survey
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Unchanged 300 50 0 Form and Instruction 1 Web-based Survey
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Unchanged 300 50 0 Form and Instruction 1 2018 AHRQ QI SURVEY
Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan Unchanged 80 50 0 Form and Instruction 1 Appendix A: Individual Respondent Characteristics Survey
Form and Instruction 2 Appendix B: Safety Attitude Survey
Form and Instruction 3 Appendix C: Pre-Test Interview Protocol
Form and Instruction 4 Appendix D: Post-test Evaluation Interview Protocol
Form and Instruction 1a Appendix A_Respondent Characteristics_final_6 17 21
Form and Instruction 3a Appendix C_Pre-test Interview Protocol_final_ 6 17 21
Form and Instruction 4a Appendix D_Post-test Interview Protocol final 6 17 21
Building Diagnostic Safety Capacity - Diagnostic Safety Measurement Resource Evaluation Plan Unchanged 160 155 0 Form and Instruction 1 Appendix A: Organizational Characteristics Survey
Form and Instruction 2 Appendix B: Organizational Readiness for Implementation Change (ORIC)
Form and Instruction 3 Appendix C: Pre-Test Interview Protocol
Form and Instruction 3 Appendix D: Post-test Evaluation Interview Protocol
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Unchanged 641 389 0 Form and Instruction 1 Appendix A: Setting Demographics Survey
Form 2 Appendix B: Individual Respondent Characteristics (Providers)
Form and Instruction 3 Appendix C: Individual Respondent Characteristics (Staff)
Form and Instruction 4 Appendix D: Individual Respondent Characteristics (Admin)
Form and Instruction 5 Appendix E: Organizational Readiness for Implementation Change (ORIC)
Form and Instruction 6 Appendix F: Pilot Test Interview Protocol for Providers – TeamSTEPPS®
Form and Instruction 7 Appendix G: Pilot Test Interview Protocol for Providers – No TeamSTEPPS®
Form and Instruction 8 Appendix H: Pilot Test Evaluation Protocol for Staff – TeamSTEPPS®
Form and Instruction 9 Appendix I: Pilot Test Evaluation Protocol for Staff – No TeamSTEPPS®
Form and Instruction 10 Appendix J: Pilot Test Evaluation Protocol for Administrators – TeamSTEPPS®
Form and Instruction 11 Appendix K: Pilot Test Evaluation Protocol for Administrators – No TeamSTEPPS®
Form and Instruction 12 Appendix L: Training Observation Tool
Card Sort A: Online Data Collection for AHRQ.gov Unchanged 100 25 0 Form and Instruction 1 Card Sort A: Online Data Collection for AHRQ.gov
Card Sort B: Online Data Collection for AHRQ.gov Unchanged 100 25 0 Form and Instruction 1 Card Sort B: Online Data Collection for AHRQ.gov
Customer Satisfaction Analysis for the AHRQ National Healthcare Quality and Disparities Report and National Quality Strategy Products and Websites Unchanged 40 40 0 Form and Instruction 1 Attachment A—AHRQ National Healthcare Quality and Disparities Reports (QDR) and National Quality Strategy (NQS) Customer Satisfaction Interview Guide
ECHO National Nursing Home COVID-19 Action Network Customer Satisfaction Survey Unchanged 4571 505 0 Form and Instruction 1 Appendix A
ED PQI Feedback Survey New 50 17 0 Form and Instruction 1 ED PQI Feedback Survey
End user Survey to support redesign of the National Center for Excellence in Primary Care Research website Unchanged 30 45 0 Form and Instruction 1 End user Survey to support redesign of the NCEPCR website: Primary Care clinicians/Quality Improvement Leaders
Form and Instruction 2 End user Survey to support redesign of the NCEPCR website: Primary Care clinicians/Quality Improvement Leaders
Form and Instruction 3 End user Survey to support redesign of the NCEPCR website: Primary Care Researchers
Form and Instruction 4 Post Website Evaluation
Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum Unchanged 72 108 0 Form and Instruction 2 2. Appendix B – Moderator Guide
Other-screener
Other-Feedback
Health Information Technology Professional Interview Guide Unchanged 18 9 0 Form and Instruction 1 Health Information Technology Professional Interview Guide
Health Services and Primary Care Research (HSPCR) Study, Stakeholder Interviews Unchanged 40 60 0 Form and Instruction 1 HSPCR Interview Guide: Other Stakeholders in HSR and PCR
Form and Instruction 2 HSPCR Interview Guide: Researchers in HSR and PCR
Information Gathering and Usability Testing for AHRQ Data Tools Platform Development and Maintenance Unchanged 50 50 0 Form and Instruction 1 AHRQ Data Tools Interview Guide
Information Gathering and Usability Testing to Harmonize AHRQ Data Tools Unchanged 50 50 0 Form and Instruction 1 INTERVIEW DISCUSSION GUIDES
MONAHRQ Program Evaluation End User Focus Groups Protocol Unchanged 64 96 0 Instruction
Form and Instruction 2 MONAHRQ Professional End Users Focus Group protocol
Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Unchanged 20 20 0 Form and Instruction 1 Nominator Customer Satisfaction Survey
Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Unchanged 20 20 0 Form and Instruction 1 Nominator Customer Satisfaction Survey
Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Unchanged 20 20 0 Form and Instruction 1 Nominator/Partner Survey
Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Unchanged 20 20 0 Form and Instruction 1 Nominator/Partner Survey
Patient Interview Guide Unchanged 18 9 0 Form and Instruction 1 Patient Interview Guide
Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Unchanged 40 10 0 Form and Instruction 1 Patient Key Informants
Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Unchanged 40 10 0 Form and Instruction 1 Questions for Patient Key Informants
Provider Interview Guide Unchanged 18 9 0 Form and Instruction 1 Provider Interview Guide
QI Program User Survey Unchanged 400 67 0 Form 1 Survey Instrument – QI Software Users
Readiness for Change Assessment Unchanged 18 9 0 Form and Instruction 1 Readiness for Change Assessment
Request for Opioid Project Information from Patient Safety Organizations (PSOs) Unchanged 40 7 0 Form and Instruction 1 Request for Opioid Project Information
Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program Unchanged 400 100 0 Form and Instruction 1 Questions for Stakeholders
Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program Unchanged 400 100 0 Form and Instruction 1 Stakeholders
Stakeholder Interviews for Task 1 of AHRQ's SPPC-II Contract (RFTOP #17-233-SOL-00520) Unchanged 15 10 0 Form and Instruction 1 Category 1
Form and Instruction 2 Category 2
Form and Instruction 3 Category 3
Form and Instruction 4 Category 4
Form and Instruction 5 Category 5
Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Unchanged 680 565 0 Form and Instruction 1 Appendix A
Form and Instruction 2 Appendix B
Form and Instruction 3 Appendix C
Form and Instruction 4 Appendix D
Form and Instruction 5 Appendix E
Form and Instruction 6 Appendix F
Form and Instruction 7 Appendix
System Usability Scale (SUS) Unchanged 180 14 0 Form and Instruction 1 System Usability Scale (SUS)
TA User Feedback for Program and User Support and Quality Measure Tool Development for CAHPS® and SOPS Unchanged 240 12 0 Form and Instruction 1 Proposed Approach for Task 3
Form and Instruction 2 Proposed Approach for Task 7
Technical Assistance (TA) User Feedback for Program and User Support and Quality Measure Tool Development for Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Surveys on Patient Sa Unchanged 120 6 0 Form and Instruction 1 Questions for Users of SOPS Technical Assistance
Form and Instruction 2 Questions for Users of CAHPS Technical Assistance
The AHRQ Safety Program for Improving Surgical Care and Recovery (ISCR) Qualitative Evaluation Unchanged 54 54 0 Form and Instruction 1 Appendix A: Interview Protocol
Voluntary Customer Satisfaction Survey of AHRQ PSNet Users Unchanged 225 35 0 Form and Instruction 1 Usability Script
Form and Instruction 2 Web Screener Survey
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 11719 3178 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title