AHRQ Publicity Center Patient-Centered Outcomes Research Awareness Campaign Health Care Provider Concept Testing

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0124 can be found here:

Documents and Forms

Document Name Document Type
Form Form #1 AHRQ Publicity Center Patient-Centered Outcomes Research Awareness Campaign Health Care Provider Concept Testing Form and Instruction
Form #1 Screening Questionnaire Attachment A - Screening Questionnaire.docx Form and Instruction
Form #2 Focus Group Moderator Guide Attachment B - Focus Group Moderator Guide.docx Form and Instruction
Supporting Statement Part A -- AHRQ Publicity Center Patient-Centered Outcomes Research 4 12 12.docx Supporting Statement Part A -- AHRQ Publicity Center Patient-Centered Outcomes Research 4 12 12 IC Document
Attachment C - Focus Group Consent Form.docx Attachment C - Focus Group Consent Form IC Document
Attachment D - Draft Advertisements.pptx Attachment D - Draft Advertisements IC Document

Information Collection (IC) Details

IC Title:	AHRQ Publicity Center Patient-Centered Outcomes Research Awareness Campaign Health Care Provider Concept Testing	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #1	Screening Questionnaire	Attachment A - Screening Questionnaire.docx		Yes	Yes	Paper Only
Form and Instruction	Form #2	Focus Group Moderator Guide	Attachment B - Focus Group Moderator Guide.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 410	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	410	0	0	0	0	0
Annual IC Time Burden (Hours)	162	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement Part A -- AHRQ Publicity Center Patient-Centered Outcomes Research 4 12 12	Supporting Statement Part A -- AHRQ Publicity Center Patient-Centered Outcomes Research 4 12 12.docx	04/13/2012
Attachment C - Focus Group Consent Form	Attachment C - Focus Group Consent Form.docx	04/13/2012
Attachment D - Draft Advertisements	Attachment D - Draft Advertisements.pptx	04/13/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.