Form #1 Form #1 RoPR Data Collection Instrument

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment B: Questionnaires/Data Collection Instruments

The RoPR data collection system is a web based collection mechanism. The screenshots included in this section are from the live RoPR system. The online form has 9 sections.

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Public reporting burden for this collection of information is estimated to 45 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ/ CFACT Attn:  Reports Clearance Officer, Paperwork Reduction Project (0935-XXXX), 5600 Fishers Lane, Mail Stop Number 07W41A; Rockville, MD 20857

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