Information Collection Request

Bureau of Primary Health Care Patient Survey

ICR 200903-0915-001 · OMB 0915-0326 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 001-BPHC Patient S Bureau of Primary Health Care Patient Survey Form New Available
UpdatedMaterials.pdf Supplementary Document Uploaded 2009-07-08 Available
Questionnaire_V6_06222009.pdf Supplementary Document Uploaded 2009-07-08 Available
HRSA Response to OMB Comments_Final.pdf Supplementary Document Uploaded 2009-07-08 Available
Cognitive_Interview _Report_1st round _2_.pdf Supplementary Document Uploaded 2009-07-08 Available
Cognitive Interview Report_2nd round _2_.pdf Supplementary Document Uploaded 2009-07-08 Available
Approval Notice.11947.Renewal.2009.pdf Supplementary Document Uploaded 2009-07-08 Available
ss_BPHC Patient Survey - NEW - PART B.pdf Supporting Statement B Uploaded 2009-03-04 Available
Attachment 11 - Approval Notice.11947.Amend.02-06-09.pdf Supplementary Document Uploaded 2009-03-03 Available
Attachment 10 - Survey Methodology and Selection Specifications.pdf Supplementary Document Uploaded 2009-03-03 Available
Attachment 9 - Definition of Final Stratification.pdf Supplementary Document Uploaded 2009-03-03 Available
Attachment 8 - Statistical Design Plan.pdf Supplementary Document Uploaded 2009-03-03 Available
Attachment 7 - Data Security Plan.pdf Supplementary Document Uploaded 2009-03-03 Available
Attachment 6 - Technical Advisory Panel.pdf Supplementary Document Uploaded 2009-03-03 Available
Attachment 5 - Informed Consent Forms.pdf Supplementary Document Uploaded 2009-03-03 Repair queued
Attachment 4 - Letters and Materials for grantees, sites and patients.pdf Supplementary Document Uploaded 2009-03-03 Repair queued
Attachment 3 - Data elements for the survey instrument.pdf Supplementary Document Uploaded 2009-03-03 Available
Attachment 2 - Survey Instrument - 02-12-09.pdf Supplementary Document Uploaded 2009-03-03 Available
Attachment 1 - 2006 USC Title 42 Section 254b.pdf Supplementary Document Uploaded 2009-03-03 Available
ss_BPHC Patient Survey - NEW - PART A.pdf Supporting Statement A Uploaded 2009-03-04 Available
IC Document Collections
IC IDCollectionTypeStatusForm
188365 Bureau of Primary Health Care Patient Survey Form New
ICR Details
0915-0326 200903-0915-001
Historical Active
HHS/HSA
Bureau of Primary Health Care Patient Survey
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 07/14/2009
Retrieve Notice of Action (NOA) 03/10/2009
This ICR is approved consistent with revised instruments and responses to passback. Per AHRQ memo of July 7, 2009, AHRQ agrees to explicitly acknowledge, as one of the limitations of this study and in all public disclosures of the study results, that the sampling approach in this study does not provide for a true probability sample .
  Inventory as of this Action Requested Previously Approved
07/31/2011 18 Months From Approved
5,773 0 0
7,218 0 0
0 0 0

Health centers improve the health of the Nation's underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services. The survey will include a sample of patients from all four types of section 330-funded health center programs. Specifically, the survey will collect in-depth information about health center patients such as their health status, the reasons they seek care at health centers, their diagnoses, the services they utilize at health centers and elsewhere, the quality of those services, and their satisfaction with the care they receive.

US Code: 42 USC 254b Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  73 FR 75120 12/10/2008
74 FR 9251 03/03/2009
No

1
IC Title Form No. Form Name
Bureau of Primary Health Care Patient Survey 001-BPHC Patient Survey BPHC Patient Survey Instrument

  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 5,773 0 0 5,773 0 0
Annual Time Burden (Hours) 7,218 0 0 7,218 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new activity, the burden for the activity is in accordance with previous surveys conducted in 1995 and 2003.

$3,843,721
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
No
Uncollected
Susan Queen 3014431129

  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.
03/10/2009