Information Collection Request

Study of Factors Influencing Consumer Choices Among Health Plans and Clinicians

ICR 200909-0935-001 · OMB 0935-0161 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #16 Experimental Arm #5 Post-test Form and Instruction New Available
Form Form #15 Experimental Arm #4 Post-test Form and Instruction New Available
Form Form #14 Experimental Arm #3 Post-test Form and Instruction New Available
Form Form #13 Experimental Arm #2 Post-test Form and Instruction New Available
Form Form #12 Experimental Arm #1 Post-test Form and Instruction New Available
Form Form #11 Baseline/Control Arm Post-test Form and Instruction New Available
Form Form #10 Experimental Website Form and Instruction New Available
Form Form #9 Pretest Form and Instruction New Available
Form Form #8 Experimental Arm #5 Post-test Form and Instruction New Available
Form Form #7 Experimental Arm #4 Post-test Form and Instruction New Available
Form Form #6 Experimental Arm #3 Post-test Form and Instruction New Available
Form Form #5 Experimental Arm #2 Post-test Form and Instruction New Available
Form Form #4 Experimental Arm #1 Post-test Form and Instruction New Available
Form Form #3 Baseline/Control Arm Post-test Form and Instruction New Available
Form Form #2 Experimental Website Form and Instruction New Available
Form Form #1 Pretest Form and Instruction New Available
Attachment W -- Distribution of CAHPS and HEDIS Scores and Anecdote Assignment.doc Supplementary Document Uploaded 2010-03-08 Available
Attachment X -- Anecdote Construction.doc Supplementary Document Uploaded 2010-03-08 Available
Attachment Y -- Outcome and Process Variables .doc Supplementary Document Uploaded 2010-03-08 Available
KN Informed Consent_v5(2).doc Supplementary Document Uploaded 2010-03-08 Available
KN Confidentiality and Privacy Protections Doc for IRBs.doc Supplementary Document Uploaded 2010-03-08 Available
Supporting Statement Part B -- Consumer Choice Study 12 21 09.doc Supporting Statement B Uploaded 2010-03-08 Available
Attachment V -- Response to Public Comments from the ANA and HPNA.doc Supplementary Document Uploaded 2009-08-27 Available
Attachment U -- Public Comments from the ANA and HPNA.pdf Supplementary Document Uploaded 2009-08-27 Available
Attachment D - Health Plan Experiment Invitation.doc Supplementary Document Uploaded 2009-08-03 Available
Attachment C - Clinician Choice Experiment Invitation.doc Supplementary Document Uploaded 2009-08-03 Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf Supplementary Document Uploaded 2009-08-03 Available
Attachment T -- 30 Day FRN -- Study of Factors Influencing Consumer Choice Among Health Plans & Clinicians.pdf Supplementary Document Uploaded 2009-08-03 Available
Supporting Statement Part A -- Consumer Choice Study 12 18 09.pdf Supporting Statement A Uploaded 2010-03-08 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
190616 Health Plan Choice Experiment -- Experimental Arm #5 Post-test Form and Instruction NewExperimental Arm #5 Post-test
190615 Health Plan Choice Experiment -- Experimental Arm #4 Post-test Form and Instruction NewExperimental Arm #4 Post-test
190614 Health Plan Choice Experiment -- Experimental Arm #3 Post-test Form and Instruction NewExperimental Arm #3 Post-test
190613 Health Plan Choice Experiment -- Experimental Arm #2 Post-test Form and Instruction NewExperimental Arm #2 Post-test
190612 Health Plan Choice Experiment -- Experimental Arm #1 Post-test Form and Instruction NewExperimental Arm #1 Post-test
190611 Health Plan Choice Experiment -- Baseline/Control Arm Post-test Form and Instruction NewBaseline/Control Arm Post-test
190610 Health Plan Choice Experiment -- Experimental Website Form and Instruction NewExperimental Website
190609 Health Plan Choice Experiment -- Pretest Form and Instruction NewPretest
190608 Clinician Choice Experiment -- Experimental Arm #5 Post-test Form and Instruction NewExperimental Arm #5 Post-test
190607 Clinician Choice Experiment -- Experimental Arm #4 Post-test Form and Instruction NewExperimental Arm #4 Post-test
190606 Clinician Choice Experiment -- Experimental Arm #3 Post-test Form and Instruction NewExperimental Arm #3 Post-test
190605 Clinician Choice Experiment -- Experimental Arm #2 Post-test Form and Instruction NewExperimental Arm #2 Post-test
190604 Clinician Choice Experiment -- Experimental Arm #1 Post-test Form and Instruction NewExperimental Arm #1 Post-test
190603 Clinician Choice Experiment -- Baseline/Control Arm Post-test Form and Instruction NewBaseline/Control Arm Post-test
190602 Clinician Choice Experiment -- Experimental Website Form and Instruction NewExperimental Website
190601 Clinician Choice Experiment -- Pretest Form and Instruction NewPretest

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2011 12 Months From Approved
4,950 0 0
709 0 0
0 0 0





Reginfo record details
16
table that charts list of burden
IC Title Form No. Form Name
Clinician Choice Experiment -- Baseline/Control Arm Post-test Form #3
Clinician Choice Experiment -- Experimental Arm #1 Post-test Form #4
Clinician Choice Experiment -- Experimental Arm #2 Post-test Form #5
Clinician Choice Experiment -- Experimental Arm #3 Post-test Form #6
Clinician Choice Experiment -- Experimental Arm #4 Post-test Form #7
Clinician Choice Experiment -- Experimental Arm #5 Post-test Form #8
Clinician Choice Experiment -- Experimental Website Form #2
Clinician Choice Experiment -- Pretest Form #1
Health Plan Choice Experiment -- Baseline/Control Arm Post-test Form #11
Health Plan Choice Experiment -- Experimental Arm #1 Post-test Form #12
Health Plan Choice Experiment -- Experimental Arm #2 Post-test Form #13
Health Plan Choice Experiment -- Experimental Arm #3 Post-test Form #14
Health Plan Choice Experiment -- Experimental Arm #4 Post-test Form #15
Health Plan Choice Experiment -- Experimental Arm #5 Post-test Form #16
Health Plan Choice Experiment -- Experimental Website Form #10
Health Plan Choice Experiment -- Pretest Form #9

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 4,950 0 0 4,950 0 0
Annual Time Burden (Hours) 709 0 0 709 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No