Information Collection

Evaluation of AHRQ's Guide to Clincial Preventive Services--Semi-structured Interview

IC 181671 under ICR 200702-0935-001 · OMB 0935-0106.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0106 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B4 -Survey Instrument & Interview Guide for Telephone & Inperson Interviews.doc	Other-Questionnaire
AHRQ OMB Questions 8-10-07.doc AHRQ OMB Questions 8-10-07	IC Document
Attachment A1- Proposed Time Schedule.doc Attachment A1- Proposed Time Schedule	IC Document
Attachment B1 - Proposed Samples & Sampling Methods.doc Attachment B1 - Proposed Samples & Sampling Methods	IC Document
Attachment B3-Recruit Script-Semi-Structured Interview.doc Attachment B3-Recruit Script-Semi-Structured Interview	IC Document
Attachment B10 - Pilot Test Results.doc Attachment B10 - Pilot Test Results	IC Document
Supporting Statement -- Umbrella Generic Clearance.pdf Supporting Statement -- Umbrella Generic Clearance	IC Document
Supporting Statement Part A.doc Supporting Statement Part A	IC Document
Supporting Statement Part B.doc Supporting Statement Part B	IC Document
Revised Supporting Statement Part B.doc Revised Supporting Statement Part B	IC Document
terms of clearance.doc terms of clearance	IC Document

IC Title:

Evaluation of AHRQ's Guide to Clincial Preventive Services--Semi-structured Interview

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire					No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	30	0	0	0	0	0
Annual IC Time Burden (Hours)	30	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
AHRQ OMB Questions 8-10-07		08/10/2007
Attachment A1- Proposed Time Schedule		08/10/2007
Attachment B1 - Proposed Samples & Sampling Methods		08/10/2007
Attachment B3-Recruit Script-Semi-Structured Interview		08/10/2007
Attachment B10 - Pilot Test Results		08/10/2007
Supporting Statement -- Umbrella Generic Clearance		08/10/2007
Supporting Statement Part A		08/10/2007
Supporting Statement Part B		08/10/2007
Revised Supporting Statement Part B		11/07/2007
terms of clearance		11/07/2007

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

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