Future of MONAHRQ® Survey 2014: Current and Potential Host 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⚠️ Notice: This information collection may be referencing outdated material.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 Future of MONAHRQ® Survey 2014: Current and Potential Host Users Form and Instruction
1 Attachment A – Approach Document—Future of MONAHRQ® Surv Approach Document_Future of MONAHRQ Survey_2014-07-08 Final.docx Form and Instruction
Future of MONAHRQ 2014_OMB Submission Form_2014-07-08c.docx Supporting Statement IC Document
OMB Cover Letter.doc Cover Page IC Document
OMB Cover Letter.doc Cover Page IC Document

Information Collection (IC) Details

IC Title:	Future of MONAHRQ® Survey 2014: Current and Potential Host 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	Attachment A – Approach Document—Future of MONAHRQ® Survey 2014	Approach Document_Future of MONAHRQ Survey_2014-07-08 Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,205	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,205	2,205
Annual IC Time Burden (Hours)	551	551
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Future of MONAHRQ 2014_OMB Submission Form_2014-07-08c.docx	07/30/2014
Cover Page	OMB Cover Letter.doc	07/30/2014
Cover Page	OMB Cover Letter.doc	07/30/2014

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