Environmental Scan for Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

OMB: 0935-0124

IC ID: 219183

Information Collection (IC) Details

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Environmental Scan for Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 Attachment B: Key Informant Interview Guide- In-person Attachment B Interview Guides_InPerson20151113docx.docx No   Fillable Fileable
Form and Instruction 4 Attachment D: Interview Guide for Case Study Development- In-person Attachment D Interview Guides_Case Study_In Person 20151113docx.docx No   Fillable Fileable
Form and Instruction 6 Attachment F: Interview Guide for Patients/Family Members/Caregivers- In-person Attachment F PatientsFamilyInterview Guide_In_Person 20151113.docx No   Fillable Fileable
Form and Instruction 8 Attachment H: Interview Guide for Primary Care Practice Staff and Physicians- In-person Attachment H Interview Guide PCP StaffPhysicians_Telephone 20151113.docx No   Fillable Fileable
Form and Instruction 1 Attachment A: Key Informant Interview Guide- Telephone Attachment A Interview Guides_Telephone 20151113docx.docx No   Fillable Fileable
Form and Instruction 3 Attachment C: Interview Guide for Case Study Development- Telephone Attachment C Interview Guides_Telephone 20151113docx.docx No   Fillable Fileable
Form and Instruction 5 Attachment E: Interview Guide for Patients/Family Members/Caregivers- Telephone Attachment E PatientsFamilyInterview Guide_Telephone 20151113.docx No   Fillable Fileable
Form and Instruction 7 Attachment G: Interview Guide for Primary Care Practice Staff and Physicians- Telephone Attachment G Interview Guide PCP StaffPhysicians_Telephone 20151113.docx No   Fillable Fileable

Health Health Care Services

 

48 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 48 0 48 0 0 0
Annual IC Time Burden (Hours) 43 0 43 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letter TO3 OMB Cover Letter 20151030 Draft.doc 12/04/2015
Supporting Statement Clearance Form 20151120.docx 12/04/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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