View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Customer Satisfaction with HIE Evaluation Toolkit
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #1 Screening Questionnaire Attachment E - Screening Questionnaire.docx Yes Yes Fillable Fileable
Form and Instruction Form #4 In-depth Interview Guide Attachment C - In-depth Interview Guide.docx Yes Yes Fillable Fileable
Form and Instruction Form #2 Monthly E-mail Check-in Text Attachment A - Monthly Email Check-in Text.docx Yes Yes Fillable Fileable
Form and Instruction Form #3 Monthly Check-in Phone Follow-up Attachment B - Monthly Check-in Phone Follow-up.docx Yes Yes Fillable Fileable

Health Immunization Management

 

60 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 120 0 0 0 0 0
Annual IC Time Burden (Hours) 34 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment D - Recruitment Email Attachment D - Recruitment Email.docx 01/17/2012
Attachment F - Final Mail to Non-Responders to Two Monthly Follow-ups Attachment F - Final Mail to Non-Responders to Two Monthly Follow-ups.docx 01/17/2012
OMB Submission Form - Customer Satisfaction with AHRQ's HIE Evaluation Toolkit OMB Submission Form - Customer Satisfaction with AHRQ's HIE Evaluation Toolkit.docx 01/17/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.