Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
7706	Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality	Migrated

ICR Details

OMB Control No: 0935-0106	ICR Reference No: 200409-0935-002
Status: Historical Active	Previous ICR Reference No: 200202-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/03/2005
	Date Received in OIRA: 09/30/2004
Terms of Clearance: Approved consistent with AHRQ memo submitted to OMB 12/08/04 detailing Privacy Act Language that will accompany collections under this generic clearance as appropriate. This generic collection is approved on the following conditions :(1) AHRQ must seek and receive OMB approval for each individual survey prior to using the survey in the field. (2) AHRQ will provide a discussion of any proposed incentives and Privacy Act Requirements in each submission under this generic (3) AHRQ will provide the total approved burden, the requested burden, and the total burden currently in use under the generic clearance with each submission. OMB will review requests under this clearance within 10 days of submission and will either approve requested collections or provide questions and comments.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2008	01/31/2008	12/31/2004
Responses	103,400	0	112,800
Time Burden (Hours)	16,356	0	20,667
Cost Burden (Dollars)	515,732,000	0	515,732,000

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Abstract: Surveys will assess strengths and weaknesses of agency program services including querying individuals using AHRQ paper and electronic products to determine satisfaction with form and content or to assess effects of streamlining efforts.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality

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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	103,400	112,800	0	-9,400	0	0
Annual Time Burden (Hours)	16,356	20,667	0	-4,311	0	0
Annual Cost Burden (Dollars)	515,732,000	515,732,000	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: Yes

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 09/30/2004

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