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 ICR - OIRA Conclusion
OMB Control No:
0935-0268
ICR Reference No:
202406-0935-001
Status:
Active
Previous ICR Reference No:
Agency/Subagency:
HHS/AHRQ
Agency Tracking No:
Title:
Implementation and Testing of Diagnostic Safety Resources
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:
07/29/2024
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/14/2024
Terms of Clearance:
OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2027
36 Months From Approved
Responses
80,169
0
0
Time Burden (Hours)
8,050
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
Improving diagnostic safety and quality is an AHRQ priority. In recognition of the multifaceted approach needed to effectively advance diagnostic safety, AHRQ supported the development of three tool -- Calibrate Dx, Measure Dx, and the Patient Toolkit -- to prevent diagnostic errors and have prioritized these tools for implementation and testing. These resources vary in the types of stakeholders they target. The goal of this research is to implement and test these three diagnostic safety resources to identify specific ways in which each resource can be used to maximize its value.
Authorizing Statute(s):
US Code:
42 USC 299a
Name of Law: The Public Health and Welfare
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:
89 FR 16574
03/07/2024
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 44983
05/22/2024
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
20
IC Title
Form No.
Form Name
1. Attachment A - Site Interest Form
1
Site Interest Form
10. Attachment K - Measure Dx Organizational Self-Assessment
10
Measure Dx Data Collection Instrument
11. Attachment L - Measure Dx Declaration of Measurement Strategy
11
Measure Dx Data Collection Instrument
12. Attachment M - Diagnostic Safety Event Report
12
Site Data Submission Form
13. Omnibus Safety and Culture Survey
13b, 13a
Omnibus Survey of Diagnostic Safety Culture: Medical Offices
,
Omnibus Survey of Diagnostic Safety Culture: Hospitals
14. Attachment P - Calibrate Dx Survey
14
Calibrate Dx: Diagnostic Calibration Debrief Tool
15. Attachment Q - Clinical Self-Efficacy Survey
15
Clinical Self-Efficacy for Diagnostic Decision-Making
16. Attachment R - Provider Characteristics Form
16
Toolkit for Engaging Patients Provider Demographic Survey
17. Attachment S - Patient Toolkit Survey-Provider
17
Patient ToolKit Survey-Provider
18. Attachment T - Provider Interview Protocol
18
Provider Interview Protocol
19. Attachment U - Patient Toolkit Survey - Patient
19
Patient Survey
2. Attachment B - Site Information Form
2
Site Information Form
20. Attachment V - Patient Interview Protocol
20
Patient Interview Protocol
3. Attachment C - Safer Dx Checklist
3
The Safer Dx Checklist: 10 High-Priority Practices for Diagnostic Excellence
4. Attachment D - Exit Interview Protocol for Attritor Sites
4
Exit Interview Protocol for Attritor Sites
5. Diagnostic Safety Supplemental Set
5a, 5b
Medical Office Survey on Patient Safety
,
Hospital Survey on Patient Safety
6. Attachment G - Post-training Evaluation Form
6
Post-Training Evaluation Form
7. Attachment H - Post-Technical Assistance Evaluation Form
7
Post-Technical Assistance Evaluation Form
8. Attachment I - Clinical Sustainability Assessment Tool (CSAT)
8
Clinical Sustainability Assessment Tool
9. Attachment J - Implementation Interviews Protocol
9
Interview Protocol: Implementation Experience
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
80,169
0
0
80,169
0
0
Annual Time Burden (Hours)
8,050
0
0
8,050
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 is a new ICR.
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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?
No
Agency Contact:
Michelle Roberts 301 427-1645 michelle.roberts@ahrq.hhs.gov
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:
06/14/2024
An official website of the United States government
The .gov means it's official.
The site is secure.
