Information Collection

Voluntary Customer Satisfaction Survey of AHRQ PSNet and AHRQ WebM&M Users

IC 211832 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⚠️ Notice: This information collection may be referencing outdated material.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 1 Voluntary Customer Satisfaction Survey of AHRQ PSNet and AHRQ WebM&M Users	Form and Instruction
1 AHRQ Patient Safety Network (PSNet)/WebM&M User Satisfac 2014-CSS-Combined Survey (PSNet).docx	Form and Instruction
OMB Cover Letter.doc Cover Letter	IC Document
Clearance Form.docx Clearance Form	IC Document

IC Title:

Voluntary Customer Satisfaction Survey of AHRQ PSNet and AHRQ WebM&M Users

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	1	AHRQ Patient Safety Network (PSNet)/WebM&M User Satisfaction Survey	2014-CSS-Combined Survey (PSNet).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Letter	OMB Cover Letter.doc	06/10/2014
Clearance Form	Clearance Form.docx	06/10/2014

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