CAHPS II Reports Laboratory Experiment

ICR 200408-0935-002

OMB: 0935-0121

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
7725
Migrated
ICR Details
0935-0121 200408-0935-002
Historical Active
HHS/AHRQ
CAHPS II Reports Laboratory Experiment
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 08/31/2004
Retrieve Notice of Action (NOA) 08/26/2004
Approved consistent with AHRQ memo submitted to OMB on 08/25/2004. AHRQ is reminded that pilot testing as discussed in the package falls under the requirements of the PRA. AHRQ must provide copies of all final data quality reporting instruments to OMB prior to fielding.
  Inventory as of this Action Requested Previously Approved
04/30/2005 04/30/2005
1 0 0
557 0 0
0 0 0

Laboratory experiment to assess ways to make reporting of information on health care quality effective. Purposive sample of adults.

None
None


No

1
IC Title Form No. Form Name
CAHPS II Reports Laboratory Experiment

  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 1 0 0 1 0 0
Annual Time Burden (Hours) 557 0 0 557 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/26/2004


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