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:
202501-0935-001
Status:
Active
Previous ICR Reference No:
202310-0935-001
Agency/Subagency:
HHS/AHRQ
Agency Tracking No:
Title:
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
03/07/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/24/2025
Terms of Clearance:
The agency will submit individual collections under this generic clearance to OMB. These submissions will include the actual study instruments along with a memo describing the specific study goal, the study design, any incentives to be used, and the sampling and analysis plans.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2026
11/30/2026
11/30/2026
Responses
10,900
0
10,900
Time Burden (Hours)
3,383
0
3,383
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:
88 FR 44806
07/13/2023
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 67290
09/29/2023
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
9
IC Title
Form No.
Form Name
AHRQ.gov Taxonomy Tree Test
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
1
Appendix A
Agency for Healthcare Research and Quality (AHRQ) COVID-19 Primary Care Learning Community Participant Survey
1
PCLC Survey
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey
1, 2
AHRQ QI Survey 2025 - Clean
,
AHRQ QI Survey 2025 - Track Changes
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey
1
Web-based Survey
Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan
1a, 3a, 4a, 1, 2, 3, 4
Appendix A: Individual Respondent Characteristics Survey
,
Appendix B: Safety Attitude Survey
,
Appendix C: Pre-Test Interview Protocol
,
Appendix D: Post-test Evaluation Interview Protocol
,
Appendix A_Respondent Characteristics_final_6 17 21
,
Appendix C_Pre-test Interview Protocol_final_ 6 17 21
,
Appendix D_Post-test Interview Protocol final 6 17 21
Building Diagnostic Safety Capacity - Diagnostic Safety Measurement Resource Evaluation Plan
1, 2, 3, 3
Appendix A: Organizational Characteristics Survey
,
Appendix B: Organizational Readiness for Implementation Change (ORIC)
,
Appendix C: Pre-Test Interview Protocol
,
Appendix D: Post-test Evaluation Interview Protocol
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
Appendix A: Setting Demographics Survey
,
Appendix B: Individual Respondent Characteristics (Providers)
,
Appendix C: Individual Respondent Characteristics (Staff)
,
Appendix D: Individual Respondent Characteristics (Admin)
,
Appendix E: Organizational Readiness for Implementation Change (ORIC)
,
Appendix F: Pilot Test Interview Protocol for Providers – TeamSTEPPS®
,
Appendix G: Pilot Test Interview Protocol for Providers – No TeamSTEPPS®
,
Appendix H: Pilot Test Evaluation Protocol for Staff – TeamSTEPPS®
,
Appendix I: Pilot Test Evaluation Protocol for Staff – No TeamSTEPPS®
,
Appendix J: Pilot Test Evaluation Protocol for Administrators – TeamSTEPPS®
,
Appendix K: Pilot Test Evaluation Protocol for Administrators – No TeamSTEPPS®
,
Appendix L: Training Observation Tool
Card Sort A: Online Data Collection for AHRQ.gov
1
Card Sort A: Online Data Collection for AHRQ.gov
Card Sort B: Online Data Collection for AHRQ.gov
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
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
1
Appendix A
ED PQI Feedback Survey
1
ED PQI Feedback Survey
End user Survey to support redesign of the National Center for Excellence in Primary Care Research website
1, 2, 3, 4
End user Survey to support redesign of the NCEPCR website: Primary Care clinicians/Quality Improvement Leaders
,
End user Survey to support redesign of the NCEPCR website: Primary Care clinicians/Quality Improvement Leaders
,
End user Survey to support redesign of the NCEPCR website: Primary Care Researchers
,
Post Website Evaluation
Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum
2
2. Appendix B – Moderator Guide
Health Information Technology Professional Interview Guide
1
Health Information Technology Professional Interview Guide
Health Services and Primary Care Research (HSPCR) Study, Stakeholder Interviews
2, 1
HSPCR Interview Guide: Other Stakeholders in HSR and PCR
,
HSPCR Interview Guide: Researchers in HSR and PCR
Information Gathering and Usability Testing for AHRQ Data Tools Platform Development and Maintenance
1
AHRQ Data Tools Interview Guide
Information Gathering and Usability Testing to Harmonize AHRQ Data Tools
1
INTERVIEW DISCUSSION GUIDES
MONAHRQ Program Evaluation End User Focus Groups Protocol
2
MONAHRQ Professional End Users Focus Group protocol
Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
1
Nominator Customer Satisfaction Survey
Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
1
Nominator Customer Satisfaction Survey
Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
1
Nominator/Partner Survey
Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
1
Nominator/Partner Survey
Patient Interview Guide
1
Patient Interview Guide
Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
1
Patient Key Informants
Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
1
Questions for Patient Key Informants
Provider Interview Guide
1
Provider Interview Guide
QI Program User Survey
1
Survey Instrument – QI Software Users
Readiness for Change Assessment
1
Readiness for Change Assessment
Request for Opioid Project Information from Patient Safety Organizations (PSOs)
1
Request for Opioid Project Information
Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program
1
Questions for Stakeholders
Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program
1
Stakeholders
Stakeholder Interviews for Task 1 of AHRQ's SPPC-II Contract (RFTOP #17-233-SOL-00520)
2, 5, 1, 3, 4
Category 1
,
Category 2
,
Category 3
,
Category 4
,
Category 5
Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract
1, 2, 3, 4, 5, 6, 7
Appendix A
,
Appendix B
,
Appendix C
,
Appendix D
,
Appendix E
,
Appendix F
,
Appendix
System Usability Scale (SUS)
1
System Usability Scale (SUS)
TA User Feedback for Program and User Support and Quality Measure Tool Development for CAHPS® and SOPS
1, 2
Proposed Approach for Task 3
,
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
2, 1
Questions for Users of SOPS Technical Assistance
,
Questions for Users of CAHPS Technical Assistance
The AHRQ Safety Program for Improving Surgical Care and Recovery (ISCR) Qualitative Evaluation
1
Appendix A: Interview Protocol
Voluntary Customer Satisfaction Survey of AHRQ PSNet Users
1, 2
Usability Script
,
Web Screener 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
10,900
0
0
0
0
Annual Time Burden (Hours)
3,383
3,383
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$848,556
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:
Amie Park 301 427-1662 amie.park@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:
01/24/2025
An official website of the United States government
The .gov means it's official.
The site is secure.
