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

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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

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:

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 %

	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

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.