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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #1 National Guideline Clearinghouse(TM) (NGC) National Quality Measures Clearinghouse(TM) (NQMC)	Form and Instruction	New	Available
Form Form #1 PSO Privacy Protection Center Help Desk Survey 0935-0106	Form	New	Available
Supporting Statement Part B 10-17-07.doc	Supporting Statement B	Uploaded 2007-11-26	Available
Attachment D -- NOA 1-3-2005.pdf	Supplementary Document	Uploaded 2007-11-26	Available
Attachment B -- Examples.doc	Supplementary Document	Uploaded 2007-11-26	Available
Attachment A -- AHRQ Legislation.pdf	Supplementary Document	Uploaded 2007-11-26	Available
memocoverletter.doc	Supplementary Document	Uploaded 2007-11-26	Available
Supporting Statement Part A 10-17-07.doc	Supporting Statement A	Uploaded 2007-11-26	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188540	National Guideline Clearinghouse(TM) (NGC) National Quality Measures Clearinghouse(TM) (NQMC)	Form and Instruction	New
187340	PSO Privacy Protection Center Help Desk Survey 0935-0106	Form	New

ICR Details

OMB Control No: 0935-0106	ICR Reference No: 200712-0935-001
Status: Historical Active	Previous ICR Reference No: 200702-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/03/2008
	Date Received in OIRA: 12/14/2007
Terms of Clearance: Approved consistent with previous terms of clearance, which state:(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. Key in OMB's review of the individual items under this generic clearance will be the appropriateness of the instument and methodology for its intended purpose and consistency with the intent of this generic clearance.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved	04/30/2008
Responses	103,600	0	103,400
Time Burden (Hours)	22,118	0	16,356
Cost Burden (Dollars)	0	0	0

---

Abstract: 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.

---

Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Generic Customer Satisfaction Surveys
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 43273	08/03/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 65031	11/19/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
National Guideline Clearinghouse(TM) (NGC) National Quality Measures Clearinghouse(TM) (NQMC)	Form #2, Form #1	Expert Commentary Response Form ,   Recommended Readings Response Form
PSO Privacy Protection Center Help Desk Survey 0935-0106	Form #1	PPC Help Desk Questionnaire

---

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	103,600	103,400	0	200	0	0
Annual Time Burden (Hours)	22,118	16,356	0	5,762	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: The increase in the number of respondents and burden hours is based on a review of data collections conducted under this generic clearance.

---

Annual Cost to Federal Government: $720,000

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

---

Common Form ICR:  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:

(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: 12/14/2007

---