Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality

ICR 200409-0935-002

OMB: 0935-0106

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0935-0106 200409-0935-002
Historical Active 200202-0935-001
HHS/AHRQ
Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality
Revision of a currently approved collection   No
Regular
Approved with change 01/03/2005
Retrieve Notice of Action (NOA) 09/30/2004
Approved consistent with AHRQ memo submitted to OMB 12/08/04 detailing Privacy Act Language that will accompany collections under this generic clearance as appropriate. This generic collection is approved on the following conditions :(1) AHRQ must seek and receive OMB approval for each individual survey prior to using the survey in the field. (2) AHRQ will provide a discussion of any proposed incentives and Privacy Act Requirements in each submission under this generic (3) AHRQ will provide the total approved burden, the requested burden, and the total burden currently in use under the generic clearance with each submission. OMB will review requests under this clearance within 10 days of submission and will either approve requested collections or provide questions and comments.
  Inventory as of this Action Requested Previously Approved
01/31/2008 01/31/2008 12/31/2004
103,400 0 112,800
16,356 0 20,667
515,732,000 0 515,732,000

Surveys will assess strengths and weaknesses of agency program services including querying individuals using AHRQ paper and electronic products to determine satisfaction with form and content or to assess effects of streamlining efforts.

None
None


No

1
IC Title Form No. Form Name
Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality

  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 103,400 112,800 0 -9,400 0 0
Annual Time Burden (Hours) 16,356 20,667 0 -4,311 0 0
Annual Cost Burden (Dollars) 515,732,000 515,732,000 0 0 0 0
No
Yes

$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.
09/30/2004


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