Customer Satisfaction with AHRQ's Patient-Centered Outcomes Research (PCOR) Educational Materials

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form Form #3 Customer Satisfaction with AHRQ's Patient-Centered Outcomes Research (PCOR) Educational Materials Form
Form #3 Pre-Focus Group Questionnaire - Group1 Attachment C1 -- Pre-Focus Group Questionnaire Group1.doc Form
Form #1 Web-based Survey Attachment A -- Web-based Survey.docx Form
Form #2 Screening Questionnaire Attachment B -- Screening Questionnaire.doc Form
Form #4 Pre-Focus Group Questionnaire - Group2 Attachment C2 -- Pre-Focus Group Questionnaire Group2.doc Form
Form #5 Focus Group Moderator Guide - Group1 Attachment D1 -- Focus Group Moderator Guide Group1.doc Form
Form #6 Focus Group Moderator Guide - Group2 Attachment D2 -- Focus Group Moderator Guide Group2.doc Form
Attachment E -- Focus Group Consent Form.doc Attachment E -- Focus Group Consent Form IC Document
OMB Submission Form -- Customer Satisfaction with AHRQs PCOR Educational Materials - 5-17-2013 Final.docx OMB Submission Form -- Customer Satisfaction with AHRQs PCOR Educational Materials - 5-17-2013 Final IC Document

Information Collection (IC) Details

IC Title:	Customer Satisfaction with AHRQ's Patient-Centered Outcomes Research (PCOR) Educational Materials	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form #3	Pre-Focus Group Questionnaire - Group1	Attachment C1 -- Pre-Focus Group Questionnaire Group1.doc	Yes	Yes	Paper Only
Form	Form #1	Web-based Survey	Attachment A -- Web-based Survey.docx	Yes	Yes	Fillable Fileable
Form	Form #2	Screening Questionnaire	Attachment B -- Screening Questionnaire.doc	Yes	Yes	Paper Only
Form	Form #4	Pre-Focus Group Questionnaire - Group2	Attachment C2 -- Pre-Focus Group Questionnaire Group2.doc	Yes	Yes	Paper Only
Form	Form #5	Focus Group Moderator Guide - Group1	Attachment D1 -- Focus Group Moderator Guide Group1.doc	Yes	Yes	Paper Only
Form	Form #6	Focus Group Moderator Guide - Group2	Attachment D2 -- Focus Group Moderator Guide Group2.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,440	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	1,440	0	0	0	0	0
Annual IC Time Burden (Hours)	237	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment E -- Focus Group Consent Form	Attachment E -- Focus Group Consent Form.doc	05/22/2013
OMB Submission Form -- Customer Satisfaction with AHRQs PCOR Educational Materials - 5-17-2013 Final	OMB Submission Form -- Customer Satisfaction with AHRQs PCOR Educational Materials - 5-17-2013 Final.docx	05/22/2013

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