Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number:0935-0179)

TITLE OF INFORMATION COLLECTION: QI Program User Survey

PURPOSE: Obtain information that describes AHRQ Quality Indicators (QI) users and provides high-level information on user experience

DESCRIPTION OF RESPONDENTS:

Users of the AHRQ QI Software

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [] Other:

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name:___Karen Chaves, Director of the Division of Quality Measurement and Improvement________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [X] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [ X] No

Category of Respondent: (the options here are Public Sector or Private Sector, or both)

Both

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Public Sector	200	10 min	33.3
Private Sector	200	10 min	33.3
Totals	400		66.6

FEDERAL COST: The estimated annual cost to the Federal government is $1,946.56

Grade	Number of Hours	Value
13	32	$1,946.56
Total		$1,946.56

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The QI listserv contains the universe of individuals who might be downloading QI software, which would be our respondents. We will (1) notify users through the listserv of the availability of a new ED-PQI module at the point of downloading the new v2023 of the QI software, including a link to the page on the QI website where software may be downloaded. (2) When a user goes to download the software, they will click on the button that says, “download.” (3) At that time, they will be prompted to fill out a brief, optional survey, or to skip directly to download. If they select “skip,” they may continue directly to download the software module. If not, they will be prompted to answer the survey questions.

In 2022, there were 3,815 downloads of QI software (any module, any format) from unique users. Assuming that about 20% of users will download the new ED-PQI module, that would be 783 downloads. Assuming a response rate of about 50%, there will be roughly 400 respondents.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [X] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Survey instrument attached.