Information Collection

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

IC 199654 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⚠️ Notice: This information collection may be referencing outdated material.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 #1 AHRQ Publicity Center Patient-Centered Outcomes Research Awareness Campaign 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
OMB Submission Form -- PCOR Awareness Campaign.docx OMB Submission Form -- PCOR Awareness Campaign	IC Document
Attachment C -- Focus Group Consent Form.docx Attachment C -- Focus Group Consent Form	IC Document
Attachment D -- Draft Advertisements.pdf Attachment D -- Draft Advertisements	IC Document

IC Title:

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

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 #1	Screening Questionnaire	Attachment A -- Screening Questionnaire.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Form #2	Focus Group Moderator Guide	Attachment B -- Focus Group Moderator Guide.docx		No	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 392

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	392	0	0	0	0	0
Annual IC Time Burden (Hours)	135	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
OMB Submission Form -- PCOR Awareness Campaign	OMB Submission Form -- PCOR Awareness Campaign.docx	09/28/2011
Attachment C -- Focus Group Consent Form	Attachment C -- Focus Group Consent Form.docx	09/28/2011
Attachment D -- Draft Advertisements	Attachment D -- Draft Advertisements.pdf	09/28/2011

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