Information Collection

Use Of Patient Experience Information In Hospitals: A Survey Of Hospital Quality Leaders

IC 221802 under ICR 201606-0935-001 · OMB 0935-0234.

Documents and Forms

Document Name Document Type
Form 1 USE OF PATIENT EXPERIENCE INFORMATION IN HOSPITALS: A SURVEY OF HOSPITAL QUALITY LEADERS Form and Instruction
1 USE OF PATIENT EXPERIENCE INFORMATION IN HOSPITALS: A SU Attachment 1 Formatted Survey_RAND.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	USE OF PATIENT EXPERIENCE INFORMATION IN HOSPITALS: A SURVEY OF HOSPITAL QUALITY LEADERS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	USE OF PATIENT EXPERIENCE INFORMATION IN HOSPITALS: A SURVEY OF HOSPITAL QUALITY LEADERS	Attachment 1 Formatted Survey_RAND.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	295	295
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.