Information Collection Request

Health Literacy Item Set Supplemental to CAHPS Hospital Survey - Pretest of Proposed Questions and Methodology

ICR 200908-0935-001 · OMB 0935-0157 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #1 Mail survey with reminder card, mail and phone follow-up Form and Instruction New Available
30 Day FRN -- CAHPS Field Test of Proposed HCAHPS Health Literacy Questions and Methodology10-10-09.doc Supplementary Document Uploaded 2009-10-20 Available
Supporting Statement Part B -Health Literacy HCAHPS 11-05-2009.doc Supporting Statement B Uploaded 2009-11-05 Available
Attachment D -- 30 Day FR Notice -- Health Literacy.pdf Supplementary Document Uploaded 2009-07-28 Available
Attachment A -- AHRQ Legislation.pdf Supplementary Document Uploaded 2009-10-20 Available
Attachment C -- Pre-NotificationCoverLetters ReminderPCardLetterTelephone ScriptRev10-10-09.doc Supplementary Document Uploaded 2009-10-20 Available
Supporting Statement Part A - Health Literacy HCAHPS 11-5-2009.doc Supporting Statement A Uploaded 2009-11-05 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
190199 Mail survey with reminder card, mail and phone follow-up Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2011 18 Months From Approved
600 0 0
250 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Mail survey with reminder card, mail and phone follow-up Form #1 CAHPS Health Literacy Survey Instrument

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 600 0 0 600 0 0
Annual Time Burden (Hours) 250 0 0 250 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No