Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Document	Type	Status	Availability
Form 1 Customer Satisfaction Analysis for the AHRQ National Healthcare Quality and Disparities Report and National Quality Strategy Products and Websites	Form and Instruction	New	Available
Form 1 Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program	Form and Instruction	New	Repair queued
Form 1 Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	Form and Instruction	New	Available
Form 1 Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	Form and Instruction	New	Available
Form 2 Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum	Form and Instruction	New	Available
Form 1 AHRQ.gov Taxonomy Tree Test	Form and Instruction	New	Repair queued
Supporting Statement Part A -- Generic Clearance FINAL1.docx	Supporting Statement A	Uploaded 2014-11-04	Available
Generic Clearance Submission Template.doc	Supplementary Document	Uploaded 2011-06-28	Repair queued
Supporting Statement Part B -- Generic Clearance.docx	Supporting Statement B	Uploaded 2014-09-22	Repair queued
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document	Uploaded 2011-04-26	Available
30 Day FRN 4-18-2011.pdf	Supplementary Document	Uploaded 2011-04-26	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
225165	Customer Satisfaction Analysis for the AHRQ National Healthcare Quality and Disparities Report and National Quality Strategy Products and Websites	Form and Instruction	New
223278	Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program	Form and Instruction	New
223277	Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	Form and Instruction	New
223276	Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	Form and Instruction	New
222551	Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum	Form and Instruction	New
215883	MONAHRQ Program Evaluation End User Focus Groups Protocol	Instruction	New
214535	AHRQ.gov Taxonomy Tree Test	Form and Instruction	New

ICR Details

OMB Control No: 0935-0179	ICR Reference No: 201409-0935-009
Status: Historical Active	Previous ICR Reference No: 201104-0935-006
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/12/2014
	Date Received in OIRA: 09/24/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved	11/30/2014
Responses	10,900	0	10,900
Time Burden (Hours)	3,383	0	3,383
Cost Burden (Dollars)	0	0	0

---

Abstract: This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.

---

Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 32298	06/04/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 56585	09/22/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
AHRQ.gov Taxonomy Tree Test	1	AHRQ.gov Taxonomy Tree Test
Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program	1	Questions for Stakeholders
Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	1	Nominator Customer Satisfaction Survey
Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	1	Questions for Patient Key Informants
Customer Satisfaction Analysis for the AHRQ National Healthcare Quality and Disparities Report and National Quality Strategy Products and Websites	1	Attachment A—AHRQ National Healthcare Quality and Disparities Reports (QDR) and National Quality Strategy (NQS) Customer Satisfaction Interview Guide
Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum	2	2. Appendix B – Moderator Guide
MONAHRQ Program Evaluation End User Focus Groups Protocol	2	MONAHRQ Professional End Users Focus Group protocol

---

ICR Summary 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	10,900	0	0	0	0
Annual Time Burden (Hours)	3,383	3,383	0	0	0	0
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:

---

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

---

Common Form ICR:  No

---

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: 09/24/2014

---