Supporting Statement

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0935-0179)

TITLE OF INFORMATION COLLECTION: Future of MONAHRQ^® Survey 2014: Current and Potential Host Users

PURPOSE: MONAHRQ—My Own Network, powered by AHRQ—is innovative, free, website-generating software from the Agency for Healthcare Research and Quality (AHRQ). The purpose of the survey is to gather input on current and potential uses for MONAHRQ. We plan to use this feedback to help identify the most useful ways to improve MONAHRQ, such as adding new features. Respondents will be asked to describe their current level of involvement with MONAHRQ, satisfaction with the functions it offers, and offer suggestions for potential new features and uses for MONAHRQ.

DESCRIPTION OF RESPONDENTS:

Organizations that download MONAHRQ and generate reports to help improve health care are referred to as “Host Users.” The Future of MONAHRQ Survey 2014 will be accessible to current and prospective Host Users. Examples of Host Users include: state agencies, public health departments, hospital associations, hospital systems, and individual hospitals, multi-stakeholder alliances and coalitions, Quality Improvement Organizations (QIOs), and health plans. The following groups will be sent an email invitation to participate in the survey:

• 14,461+ members of the GovDelivery listserv

• 47 Healthcare Cost and Utilization Project (HCUP) partners

• 16 Aligning Forces for Quality (AF4Q) communities

• 17 recipients of Office of the National Coordinator for Health IT (ONC) Beacon grants

• 17 recipients of AHRQ R21 Building the Science of Public Reporting research grantees

• 31 members of the Network for Regional Healthcare Improvement

• ~50 agency staff from state agencies, with responsibility for public reporting

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [x ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name:__Kirsten Firminger________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ x ] Yes [ ] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ x ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [x ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals or organizations (assumes 15% response rate)	2,205	15 minutes	551 hours
Totals	2,205	15 minutes	551 hours

FEDERAL COST: The estimated annual cost to the Federal government is $3,800.00, which includes 1) $3,200 in instrument development, fielding, and analysis, and 2) $600 (12.5 hours at the GS-13 level) in project management and oversight.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [x ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

We will create a single “customer” list of survey recipients containing names and email addresses from the MONAHRQ listserv, from existing AIR, Pantheon Team, and AHRQ networks for the groups above.

We will send an email announcement containing a link to the survey to this audience along with two reminder emails.

Alternatively, we will email out a survey link to the MONAHRQ listserv and invite members from the groups above (potentially leading to duplicate contact) via a separate email.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[x] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Will interviewers or facilitators be used? [ ] Yes [ x] No

List of Attachments:

Attachment A – Approach Document—Future of MONAHRQ® Survey 2014