Information Collection Request

AHRQ ACTION III – Measurement for Performance Improvement in Physician Practices

ICR 201606-0935-002 · OMB 0935-0233 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Medical group administrators : All other administrators (Attachment C) Form New Available
Form 1 Medical group administrators: Initial, highest level administrators (Attachment C) Form New Available
Form 1 Attachment C Form New Available
Form 1 Frontline Clinicians (Attachment C) Form and Instruction New Available
AHRQ MPI_PRA_Supporting Statement Part B__3-25-2016.docx Supporting Statement B Uploaded 2016-06-17 Available
AHRQ MPI_PRA_Supporting Statement Part A 10172016.docx Supporting Statement A Uploaded 2016-10-17 Available
AHRQ MPI_Attachment D_Interview Consent Form_v2 (3-28-2016).docx Supplementary Document Uploaded 2016-06-15 Available
AHRQ MPI_Attachment C_Interview Protocol_v2 (3-28-2016).docx Supplementary Document Uploaded 2016-06-15 Available
AHRQ MPI_Attachment B_TEP.docx Supplementary Document Uploaded 2016-06-15 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
222009 Medical group administrators : All other administrators (Attachment C) Form NewMedical group administrators : All other administrators (Attachment C)
222008 Medical group administrators: Initial, highest level administrators (Attachment C) Form NewMedical group administrators: Initial, highest level administrators (Attachment C)
221952 Medical group administrators Form NewAttachment C
221949 Frontline Clinicians (Attachment C) Form and Instruction NewFrontline Clinicians (Attachment C)

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2019 36 Months From Approved
325 0 0
296 0 0
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Frontline Clinicians (Attachment C) 1
Medical group administrators 1
Medical group administrators : All other administrators (Attachment C) 1
Medical group administrators: Initial, highest level administrators (Attachment C) 1

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 325 0 0 325 0 0
Annual Time Burden (Hours) 296 0 0 296 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No