Form 1 Questions for Stakeholders

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

Customer Satisfaction Survey_stakeholder FINAL

Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program

OMB: 0935-0179

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Form Approved

OMB No. 0935-0179

Exp. Date 10/31/2017

Exp. Date 10/31/2017



Questions for Stakeholders

Number: approximately 10 -15 stakeholders per report, 300-450/year

Method: electronic survey sent at end of report

  1. Using any number 0 to 10 where 0 is the worst possible and 10 is the best possible, what number would you use to rate the experience of giving feedback on this report?

  2. Will the final report be useful ? (yes definitely/yes somewhat/no/comments)

  3. What else could improve our systematic reviews in the future? ___________________









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Public reporting burden for this collection of information is estimated to average 15 minutes per response, the estimated time required to complete the survey. An agency many not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-0179) AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850.

Public reporting burden for this collection of information is estimated to average 15 minutes per response, the estimated time required to complete the survey. An agency many not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-0179) AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorElisabeth Kato
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File Created2021-01-26

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