Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Questionnaire for the K Program Participants	Form and Instruction	New	Available
Form 1 Attachment C. Expert Commentary Response Form	Form and Instruction	New	Available
Supporting Statement Part B -- Customer Survey Generic Clearance 2014.doc	Supporting Statement B	Uploaded 2014-09-05	Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document	Uploaded 2011-04-04	Available
Attachment B -- Examples.doc	Supplementary Document	Uploaded 2011-04-04	Available
Supporting Statement Part A -- Generic Clearance FINAL1.docx	Supporting Statement A	Uploaded 2014-11-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214829	Return on Investment of AHRQ's Individual Career Development (K) Award Program Evaluation	Form and Instruction	New	Questionnaire for the K Program Participants
214022	National Guideline Clearinghouse - National Quality Measures Clearinghouse	Form and Instruction	New	Attachment C. Expert Commentary Response Form

ICR Details

OMB Control No: 0935-0106	ICR Reference No: 201409-0935-003
Status: Historical Active	Previous ICR Reference No: 201104-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/12/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/09/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved
Responses	10,900	0	0
Time Burden (Hours)	3,383	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Surveys will assess strengths and weaknesses of agency program services including querying individuals using AHRQ paper and electronic products to determine satisfaction with form and content or to assess effects of streamlining efforts.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
   EO: EO 12862 Name/Subject of EO: Generic Customer Satisfaction Surveys
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 30847	05/29/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 51335	08/28/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
National Guideline Clearinghouse - National Quality Measures Clearinghouse	1	Attachment C. Expert Commentary Response Form
Return on Investment of AHRQ's Individual Career Development (K) Award Program Evaluation	1	Questionnaire for the K Program Participants

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ICR Summary of Burden

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	10,900	0	0	0	0	10,900
Annual Time Burden (Hours)	3,383	0	0	0	0	3,383
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $809,619

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/09/2014

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