Information Collection Request

Updating and Expanding the AHRQ Quality Indicators Toolkit for Hospitals

ICR 201408-0935-001 · OMB 0935-0164 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #4 AHRQ QI Data Collection Tool Form and Instruction Removed Available
Form Old - Form #3 Usability Testing Protocol Form and Instruction Modified Available
Form Old - Form #2 Quarterly Update Protocol Form and Instruction Modified Available
Form Old - Form #1 Pre/Post-Test Interview Protocol Form and Instruction Modified Available
Attachment H -- Recruitment Letter.docx Supplementary Document Uploaded 2014-09-09 Available
Attachment A --- Healthcare Research and Quality Act of 1999.pdf Supplementary Document Uploaded 2014-08-15 Available
Attachment G -- RAND Human Subjects Protection Committee (IRB) Exemption Notice.pdf Supplementary Document Uploaded 2014-08-14 Available
Attachment F -- Informed consent form for pre-post interview.docx Supplementary Document Uploaded 2014-08-14 Repair queued
Supporting Statement Part B FINAL.docx Supporting Statement B Uploaded 2014-08-14 Available
Supporting Statement Part A Final 9.09.2014.docx Supporting Statement A Uploaded 2014-09-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
192333 AHRQ QI Data Collection Tool Form and Instruction Removed
192332 Usability Testing Protocol Form and Instruction Modified
192331 Quarterly Update Protocol Form and Instruction Modified
192330 Pre/Post-Test Interview Protocol Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2017 36 Months From Approved
240 0 0
240 0 0
0 0 0





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 240 0 0 240 0 0
Annual Time Burden (Hours) 240 0 0 240 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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