Evaluation of AHRQ's Guide to Clincial Preventive Services--Semi-structured Interview

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0106 can be found here:

Documents and Forms

Document Name Document Type
Attachment B4 -Survey Instrument & Interview Guide for Telephone & Inperson Interviews.doc Other-Questionnaire
AHRQ OMB Questions 8-10-07.doc AHRQ OMB Questions 8-10-07 IC Document
Attachment A1- Proposed Time Schedule.doc Attachment A1- Proposed Time Schedule IC Document
Attachment B1 - Proposed Samples & Sampling Methods.doc Attachment B1 - Proposed Samples & Sampling Methods IC Document
Attachment B3-Recruit Script-Semi-Structured Interview.doc Attachment B3-Recruit Script-Semi-Structured Interview IC Document
Attachment B10 - Pilot Test Results.doc Attachment B10 - Pilot Test Results IC Document
Supporting Statement -- Umbrella Generic Clearance.pdf Supporting Statement -- Umbrella Generic Clearance IC Document
Supporting Statement Part A.doc Supporting Statement Part A IC Document
Supporting Statement Part B.doc Supporting Statement Part B IC Document
Revised Supporting Statement Part B.doc Revised Supporting Statement Part B IC Document
terms of clearance.doc terms of clearance IC Document

Information Collection (IC) Details

IC Title:	Evaluation of AHRQ's Guide to Clincial Preventive Services--Semi-structured Interview	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire			Attachment B4 -Survey Instrument & Interview Guide for Telephone & Inperson Interviews.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 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	30	0	0	0	0	0
Annual IC Time Burden (Hours)	30	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
AHRQ OMB Questions 8-10-07	AHRQ OMB Questions 8-10-07.doc	08/10/2007
Attachment A1- Proposed Time Schedule	Attachment A1- Proposed Time Schedule.doc	08/10/2007
Attachment B1 - Proposed Samples & Sampling Methods	Attachment B1 - Proposed Samples & Sampling Methods.doc	08/10/2007
Attachment B3-Recruit Script-Semi-Structured Interview	Attachment B3-Recruit Script-Semi-Structured Interview.doc	08/10/2007
Attachment B10 - Pilot Test Results	Attachment B10 - Pilot Test Results.doc	08/10/2007
Supporting Statement -- Umbrella Generic Clearance	Supporting Statement -- Umbrella Generic Clearance.pdf	08/10/2007
Supporting Statement Part A	Supporting Statement Part A.doc	08/10/2007
Supporting Statement Part B	Supporting Statement Part B.doc	08/10/2007
Revised Supporting Statement Part B	Revised Supporting Statement Part B.doc	11/07/2007
terms of clearance	terms of clearance.doc	11/07/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.