View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View Generic ICR - OIRA Conclusion
OMB Control No:
0935-0179
ICR Reference No:
201104-0935-006
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/AHRQ
Agency Tracking No:
Title:
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/24/2011
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/28/2011
Terms of Clearance:
OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2014
36 Months From Approved
Responses
10,900
0
0
Time Burden (Hours)
3,383
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.
Authorizing Statute(s):
US Code:
42 USC 299
Name of Law: Healthcare Research and Quality Act of 1999
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
75 FR 80542
12/22/2010
30-day Notice:
Federal Register Citation:
Citation Date:
76 FR 21746
04/18/2011
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
15
IC Title
Form No.
Form Name
AHRQ Articles of Interest (AI) Survey
1
Agency for Health Research and Quality (AHRQ) Articles of Interest (AI) Survey
AHRQ Publicity Center Patient-Centered Outcomes Research Awareness Campaign Concept Testing
Form #1, Form #2
Screening Questionnaire
,
Focus Group Moderator Guide
Customer Satisfaction with AHRQ's Health IT Literacy Guide
Form #2, Form #1
Screening Instrument for Focus Groups
,
Focus Group Moderator Guide
Customer Satisfaction with AHRQ's Patient-Centered Outcomes Research (PCOR) Educational Materials
Form #3, Form #1, Form #2, Form #4, Form #5, Form #6
Pre-Focus Group Questionnaire - Group1
,
Web-based Survey
,
Screening Questionnaire
,
Pre-Focus Group Questionnaire - Group2
,
Focus Group Moderator Guide - Group1
,
Focus Group Moderator Guide - Group2
Customer Satisfaction with AHRQ's Quality Measurement Initiatives
Form #1, Form #2
MONAHRQ Host User Group Questionnaire
,
HCUP Partners Software Redesign Questionnaire
Customer Satisfaction with AHRQ's Research Activities Newsletter
Form #1
Research Activities Newsletter Questionnaire
Customer Satisfaction with HIE Evaluation Toolkit
Form #1, Form #4, Form #2, Form #3
Screening Questionnaire
,
In-depth Interview Guide
,
Monthly E-mail Check-in Text
,
Monthly Check-in Phone Follow-up
Customer Satisfaction with the 2012 Guide to Clinical Preventive Services
Form #1
Guide to Clinical Preventive Services Feedback Questionnaire
Customer Satisfaction with the AHRQ Quality Indicators (QI) and QI Software, Documentation and User Support
Form #1, Form #2
AHRQ QI Software and Documentation Questionnaire
,
Adoption and Use of AHRQ QI Questionnaire
Customer Satisfaction with the AHRQ Videonovela Aprende a vivir.
Form #1, Form #2
Attachment A -- Patient Questionnaire - Spanish Version
,
Attachment C - Health Care Professional Questionnaire
Future of MONAHRQ® Survey 2014: Current and Potential Host Users
1
Attachment A – Approach Document—Future of MONAHRQ® Survey 2014
Stakeholder Information Needs and Satisfaction with National Quality Strategy Outreach Activities
1
National Quality Strategy Stakeholder Survey of Awareness,
Voluntary Customer Satisfaction Survey of AHRQ PSNet Users
1
Customer Satisfaction Survey of AHRQ PSNet Users
Voluntary Customer Satisfaction Survey of AHRQ PSNet and AHRQ WebM&M Users
1
AHRQ Patient Safety Network (PSNet)/WebM&M User Satisfaction Survey
Voluntary Customer Satisfaction Survey of AHRQ WebM&M Users
1
AHRQ WebM&M Customer Satisfaction Survey
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
10,900
0
0
10,900
0
0
Annual Time Burden (Hours)
3,383
0
0
3,383
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This Information Collection Request is for a new generic clearance to allow AHRQ to improve its service delivery.
Annual Cost to Federal Government:
$720,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Doris Lefkowitz 3014271477
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
04/28/2011
An official website of the United States government
The .gov means it's official.
The site is secure.
