Information Collection Request

Health IT Tool Evaluation

ICR 201106-0935-004 · OMB 0935-0182 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #5 Discussion Groups Interview Guide for Non-Users Form and Instruction New Available
Form Form #4 Discussion Groups Interview Guide for Users Form and Instruction New Available
Form Form #3 Usability Testing Interview Guide Form and Instruction New Available
Form Form #2 Needs Assessment Interview Guide Form and Instruction New Available
Form Form #1 Screening and Demographics Questionnaire Form and Instruction New Available
Supporting Statement Part B - Health IT Tool Evaluation 6-2-2011.docx Supporting Statement B Uploaded 2011-06-06 Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf Supplementary Document Uploaded 2011-06-06 Available
Attachment J -- Public Comment and AHRQs Response.docx Supplementary Document Uploaded 2011-06-06 Available
Attachment I -- Federal Register Notice.pdf Supplementary Document Uploaded 2011-06-06 Available
Attachment H -- Recruiting Communication Scheduling Protocol.docx Supplementary Document Uploaded 2011-06-06 Available
Attachment G -- Recruiting Communication Flyer.docx Supplementary Document Uploaded 2011-06-06 Available
Attachment F -- Recruiting Communication Request to Organizations.docx Supplementary Document Uploaded 2011-06-06 Available
Supporting Statement Part A - Health IT Tool Evaluation 6-2-2011.docx Supporting Statement A Uploaded 2011-06-06 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
198045 Discussion Groups Form and Instruction NewDiscussion Groups Interview Guide for Non-Users
198045 Discussion Groups Form and Instruction NewDiscussion Groups Interview Guide for Users
198044 Usability Testing Form and Instruction NewUsability Testing Interview Guide
198043 Needs Assessment Form and Instruction NewNeeds Assessment Interview Guide
198042 Screening Questionnaire Form and Instruction NewScreening and Demographics Questionnaire

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2013 24 Months From Approved
220 0 0
147 0 0
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Discussion Groups Form #4, Form #5 ,  
Needs Assessment Form #2
Screening Questionnaire Form #1
Usability Testing Form #3

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 220 0 0 220 0 0
Annual Time Burden (Hours) 147 0 0 147 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No