Information Collection

Customer Satisfaction with AHRQ's Health IT Literacy Guide

IC 199213 under ICR 201104-0935-006 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #2 Customer Satisfaction with AHRQ's Health IT Literacy Guide	Form and Instruction
Form #2 Screening Instrument for Focus Groups Attachment C - Screening Instrument for Focus Groups 091311.docx	Form and Instruction
Form #1 Focus Group Moderator Guide Attachment A - Focus Group Moderator Guide 091311.docx	Form and Instruction
Attachment D - Focus Group Consent Form 091311.docx Attachment D - Focus Group Consent Form 091311	IC Document
Attachment B - Text for Initial Participant Email 091311.docx Attachment B - Text for Initial Participant Email 091311	IC Document
OMB Submission Form -- Customer Satisfaction with AHRQ's Health IT Literacy Guide 091311.docx OMB Submission Form -- Customer Satisfaction with AHRQ's Health IT Literacy Guide 091311	IC Document

IC Title:

Customer Satisfaction with AHRQ's Health IT Literacy Guide

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #2	Screening Instrument for Focus Groups	Attachment C - Screening Instrument for Focus Groups 091311.docx		Yes	Yes	Paper Only
Form and Instruction	Form #1	Focus Group Moderator Guide	Attachment A - Focus Group Moderator Guide 091311.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 126

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 %

table that charts list of burden
	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	126	0	0	0	0	0
Annual IC Time Burden (Hours)	106	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D - Focus Group Consent Form 091311	Attachment D - Focus Group Consent Form 091311.docx	09/13/2011
Attachment B - Text for Initial Participant Email 091311	Attachment B - Text for Initial Participant Email 091311.docx	09/13/2011
OMB Submission Form -- Customer Satisfaction with AHRQ's Health IT Literacy Guide 091311	OMB Submission Form -- Customer Satisfaction with AHRQ's Health IT Literacy Guide 091311.docx	09/13/2011

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