SUBMISSION OF INFORMATION COLLECTION UNDER THE
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
DATE OF REQUEST: August 30, 2016
SUB AGENCY (I/C): HHS/AHRQ
TITLE: Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program
Practice Center (EPC) Division
GENERIC CLEARANCE UNDER OMB#: 0925-0179 EXP. DATE: 11/30/2017
	The mission of the EPC
	program is to create reports that improve healthcare by supporting
	evidence-based decision making by patients, providers, and
	policymakers.  To ensure that our reports answer the questions that
	are important to these stakeholders and to facilitate dissemination
	of our reports, we notify stakeholders at several key points during
	the systematic review development process. When we are beginning a
	systematic review, we identify stakeholders who may be interested in
	the topic.  We then notify them via email to let them know we have
	started working on a topic, when there are opportunities for public
	comment, and when the review is complete.  We want to learn more
	about their experiences receiving these updates and how we can
	improve their experiences. 
	 Respondents
	will be invited to take a brief survey via email. The survey will
	not collect or store any personally identifiable information from
	the respondent; it will only collect the name of the systematic
	review, the organization the respondent is from, and the survey
	responses. Organizations
	that download MONAHRQ and generate reports to help improve health
	care are referred to as “Host Users.” The Future of
	MONAHRQ Survey 2014 will be accessible to current and prospective
	Host Users. Examples of Host Users include: state agencies, public
	health departments, hospital associations, hospital systems, and
	individual hospitals, multi-stakeholder alliances and coalitions,
	Quality Improvement Organizations (QIOs), and health plans.
	
	
	
	
TOTAL ANNUAL BURDEN APPROVED: 3,383 Hours Per year
BURDEN USED TO DATE: 404 hours.
BURDEN THIS REQUEST: 100 hours.
FEDERAL COST: The estimated annual cost to the Federal government is $5,500_____.
IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?
______YES ______ NO _____x_ N/A
OBLIGATION TO RESPOND:
___x___ VOLUNTARY
______ REQUIRED TO OBTAIN OR RETAIN BENEFITS
______ MANDATORY
HOW WILL THIS SURVEY BE OFFERED?
___x_ WEB SITE
____ TELEPHONE INTERVIEW
_____ MAIL RESPONSE
_____ IN PERSON INTERVIEW
_____ OTHER: ___________________________________
CONTACT INFORMATION:
NAME: _Erwin Brown______________________________
TELEPHONE NUMBER: 301.427.1652________________
EMAIL ADDRESS: _ebrown@ahrq.gov________________
| File Type | application/msword | 
| File Title | Generic Clearance Form - 04/28/2008 | 
| Subject | Generic Clearance Form - 04/28/2008 | 
| Author | OD/USER | 
| Last Modified By | Windows User | 
| File Modified | 2016-08-31 | 
| File Created | 2016-08-31 |