Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Document Name	Status
Form 1 Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	New
Form 1 Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Form and Instruction	New
Form 1 Card Sort B: Online Data Collection for AHRQ.gov Form and Instruction	New
Form 1 Card Sort A: Online Data Collection for AHRQ.gov Form and Instruction	New
Form 1 End user Survey to support redesign of the National Center for Excellence in Primary Care Research website Form and Instruction	New
Form 1 Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	New
Form 1 Health Services and Primary Care Research (HSPCR) Study, Stakeholder Interviews Form and Instruction	New
Form 1 Information Gathering and Usability Testing to Harmonize AHRQ Data Tools Form and Instruction	New
Form 1 Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Form and Instruction	New
Form 1 System Usability Scale (SUS) Form and Instruction	New
Form 1 Health Information Technology Professional Interview Guide Form and Instruction	New
Form 1 Provider Interview Guide Form and Instruction	New
Form 1 Patient Interview Guide Form and Instruction	New
Form 1 Readiness for Change Assessment Form and Instruction	New
Form 1 Request for Opioid Project Information from Patient Safety Organizations (PSOs) Form and Instruction	New
Form 1 Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Form and Instruction	New
Form 1 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 Form and Instruction	New
Form 1 Stakeholder Interviews for Task 1 of AHRQ's SPPC-II Contract (RFTOP #17-233-SOL-00520) Form and Instruction	New
Form 1 Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program Form and Instruction	New
Form 1 Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	New
Form 1 Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	New
Form 1 Customer Satisfaction Analysis for the AHRQ National Healthcare Quality and Disparities Report and National Quality Strategy Products and Websites Form and Instruction	Unchanged
Form 1 Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program Form and Instruction	Unchanged
Form 1 Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	Unchanged
Form 1 Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	Unchanged
Form 2 Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum Form and Instruction	Unchanged
Form 1 AHRQ.gov Taxonomy Tree Test Form and Instruction	Unchanged
Supporting Statement Part A -- Generic Clearance.docx Supporting Statement A	2017-09-22
Generic Clearance Submission Template.doc Supplementary Document	2011-06-28
Supporting Statement Part B -- Generic Clearance.docx Supporting Statement B	2014-09-22
Attachment A -- Healthcare Research and Quality Act of 1999.pdf Supplementary Document	2011-04-26
30 Day FRN 4-18-2011.pdf Supplementary Document	2011-04-26

IC Document Collections

IC ID	Document Title	Status
242601	Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	New
241698	Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Form and Instruction	New
241678	Card Sort B: Online Data Collection for AHRQ.gov Form and Instruction	New
241677	Card Sort A: Online Data Collection for AHRQ.gov Form and Instruction	New
240821	End user Survey to support redesign of the National Center for Excellence in Primary Care Research website Form and Instruction	New
235082	Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	New
234568	Health Services and Primary Care Research (HSPCR) Study, Stakeholder Interviews Form and Instruction	New
234196	Information Gathering and Usability Testing to Harmonize AHRQ Data Tools Form and Instruction	New
233835	Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Form and Instruction	New
233778	System Usability Scale (SUS) Form and Instruction	New
233777	Health Information Technology Professional Interview Guide Form and Instruction	New
233776	Provider Interview Guide Form and Instruction	New
233775	Patient Interview Guide Form and Instruction	New
233758	Readiness for Change Assessment Form and Instruction	New
232977	Request for Opioid Project Information from Patient Safety Organizations (PSOs) Form and Instruction	New
231422	Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Form and Instruction	New
231329	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 Form and Instruction	New
229442	Stakeholder Interviews for Task 1 of AHRQ's SPPC-II Contract (RFTOP #17-233-SOL-00520) Form and Instruction	New
228950	Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program Form and Instruction	New
228948	Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	New
228946	Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	New
225165	Customer Satisfaction Analysis for the AHRQ National Healthcare Quality and Disparities Report and National Quality Strategy Products and Websites Form and Instruction	Unchanged
223278	Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program Form and Instruction	Unchanged
223277	Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	Unchanged
223276	Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction	Unchanged
222551	Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum Form and Instruction	Unchanged
215883	MONAHRQ Program Evaluation End User Focus Groups Protocol Instruction	Unchanged
214535	AHRQ.gov Taxonomy Tree Test Form and Instruction	Unchanged

ICR Details

OMB Control No: 0935-0179	ICR Reference No: 201709-0935-001
Status: Historical Active	Previous ICR Reference No: 201409-0935-009
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/03/2017
	Date Received in OIRA: 09/26/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2020	36 Months From Approved	11/30/2017
Responses	10,900	0	10,900
Time Burden (Hours)	3,383	0	3,383
Cost Burden (Dollars)	0	0	0

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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.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 24705	05/30/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 43376	09/15/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 28

IC Title	Form No.	Form Name
Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program	1	Questions for Stakeholders
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
Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	1	Nominator/Partner Survey
MONAHRQ Program Evaluation End User Focus Groups Protocol	2	MONAHRQ Professional End Users Focus Group protocol
System Usability Scale (SUS)	1	System Usability Scale (SUS)
Health Information Technology Professional Interview Guide	1	Health Information Technology Professional Interview Guide
Patient Interview Guide	1	Patient Interview Guide
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
Card Sort B: Online Data Collection for AHRQ.gov	1	Card Sort B: Online Data Collection for AHRQ.gov
AHRQ.gov Taxonomy Tree Test	1	AHRQ.gov Taxonomy Tree Test
Provider Interview Guide	1	Provider Interview Guide
Readiness for Change Assessment	1	Readiness for Change Assessment
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
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
Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	1	Nominator Customer Satisfaction Survey
Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum	2	2. Appendix B – Moderator Guide
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey	1	2018 AHRQ QI SURVEY
Request for Opioid Project Information from Patient Safety Organizations (PSOs)	1	Request for Opioid Project Information
Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	1	Nominator Customer Satisfaction Survey
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey	1	Web-based 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
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
Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	1	Questions for Patient Key Informants
Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program	1	Stakeholders
Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	1	Patient Key Informants
Card Sort A: Online Data Collection for AHRQ.gov	1	Card Sort A: Online Data Collection for AHRQ.gov
Information Gathering and Usability Testing to Harmonize AHRQ Data Tools	1	INTERVIEW DISCUSSION GUIDES
Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	1	Nominator/Partner Survey

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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	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:

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Annual Cost to Federal Government: $809,619

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? 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: 09/26/2017

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