Eisenberg Center Voluntary Customer Survey Generic Clearance for the AHRQ

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #7 Sample CME Followup Questionnaire	Form and Instruction	New	Available
Form Form #6 Glossary feedback questionnaire	Form and Instruction	New	Available
Form Form #5 Osteoporosis Decision Aid - feedback questionnaire	Form and Instruction	New	Available
Form Form #4 Clinician and Policymaker Summary Guides from policymakers & administrators - feedback questionnaire	Form and Instruction	New	Available
Form Form #3 Clinician and Policymaker Summary Guides from health care providers - feedback questionnaire	Form and Instruction	New	Available
Form Form #1 Consumer Summary Guides from people with the conditions - feedback questionnaire	Form and Instruction	New	Available
Form Form #2 Consumer Summary Guides from health care providers - feedback questionnaire	Form and Instruction	New	Available
SupportingStatementEisenbergCenterGenericClearance02-2007.doc	Supporting Statement B	Uploaded 2007-02-01	Available
ECQual Methods.doc	Supplementary Document	Uploaded 2007-02-01	Available
Sample Interview Procedures.doc	Supplementary Document	Uploaded 2007-02-01	Available
SupportingStatementEisenbergCenterGenericClearance02-2007.doc	Supporting Statement A	Uploaded 2007-02-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
190004	Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program	Form and Instruction	New	Sample CME Followup Questionnaire
190004	Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program	Form and Instruction	New	Glossary feedback questionnaire
190004	Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program	Form and Instruction	New	Osteoporosis Decision Aid - feedback questionnaire
190004	Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program	Form and Instruction	New	Clinician and Policymaker Summary Guides from policymakers & administrators - feedback questionnaire
190004	Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program	Form and Instruction	New	Clinician and Policymaker Summary Guides from health care providers - feedback questionnaire
190004	Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program	Form and Instruction	New	Consumer Summary Guides from people with the conditions - feedback questionnaire
190004	Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program	Form and Instruction	New	Consumer Summary Guides from health care providers - feedback questionnaire

ICR Details

OMB Control No: 0935-0128	ICR Reference No: 200702-0935-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Eisenberg Center Voluntary Customer Survey Generic Clearance for the AHRQ
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/27/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/02/2007
Terms of Clearance: This generic ICR is approved consistent with AHRQ agreement to submit individual information colletions to OMB as they are implemented, along with all necessary supporting statements. Furthermore, this generic ICR is approved on the understanding that: 1) AHRQ does not intend to use data derived from this clearance in analytic publications of any sort; 2) the intent of testing of materials already in circulation would be only to improve future products and would not in any way be an evaluation. The scope and intent of such activities would clearly be specified in the supporting statements associated with the specific collection; 3) OMB will aim to review each IC submission within 14 days; however, OMB approval should not be assumed if not explicitly granted, even if 14 days have elapsed since submission.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	36 Months From Approved
Responses	1,320	0	0
Time Burden (Hours)	1,016	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: AHRQ's newly-established Eisenberg Center is an innovative effort aimed at improving communication of findings to a variety of audiences ("customers"), including consumers, clinicians, payers, and health care policy makers. The Eisenberg Center, one of three components of AHRQ's Effective Health Care Program announced in September 2005, is directed through a contract by the Oregon Health and Science University, Department of Medicine, located in Portland, Oregon. The Eisenberg Center intends to employ the latest survey research techniques to (1) determine how well its products and services are meeting customers' current and anticipated needs; (2) identify problem areas with existing products and services and determine what improvements should be made to improve these products and services; and (3) identify and develop new products and services. To address customer requirements and to evaluate current and future AHRQ products and services, the Eisenberg Center must periodically determine how well the Eisenberg Center products and services are meeting customers' current and anticipated needs. Work conducted under this clearance will improve the products and services the Center develops for AHRQ for a three year period. The health care environment changes rapidly and requires a quick response from AHRQ to provide appropriately refined products and services. A generic clearance for this work will facilitate AHRQ's timely response to customers' needs.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 38167	07/05/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 53695	09/12/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Eisenberg Center Customer Satisfaction Survey for the Effective Health Care Program	Form #1, Form #2, Form #3, Form #4, Form #5, Form #6, Form #7	Consumer Summary Guides from people with the conditions - feedback questionnaire ,   Consumer Summary Guides from health care providers - feedback questionnaire ,   Clinician and Policymaker Summary Guides from health care providers - feedback questionnaire ,   Clinician and Policymaker Summary Guides from policymakers & administrators - feedback questionnaire ,   Osteoporosis Decision Aid - feedback questionnaire ,   Glossary feedback questionnaire ,   Sample CME Followup Questionnaire

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ICR Summary of Burden

table that charts list of burden

	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	1,320	0	0	1,320	0	0
Annual Time Burden (Hours)	1,016	0	0	1,016	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $750,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/02/2007

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