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

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Document Name Document Type
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
1 Questions for Users of SOPS Technical Assistance SOPS TA User Feedback 4-17-2018.docx Form and Instruction
2 Questions for Users of CAHPS Technical Assistance CAHPS TA User Feedback 4-17-2018.docx Form and Instruction
SOPS TA User Feedback 4-27-2018EB3.docx Supporting Statement IC Document
OMB Cover Letter.doc Cover Letter IC Document

Information Collection (IC) Details

IC Title:	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	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
Form and Instruction	1	Questions for Users of SOPS Technical Assistance	SOPS TA User Feedback 4-17-2018.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Questions for Users of CAHPS Technical Assistance	CAHPS TA User Feedback 4-17-2018.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	SOPS TA User Feedback 4-27-2018EB3.docx	05/04/2018
Cover Letter	OMB Cover Letter.doc	05/04/2018

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