Attachment D – Patient Experience Survey_Data collection instrument

AHRQ Safety Program for Improving Surgical Care and Recovery

OMB: 0935-0239

IC ID: 227745

Information Collection (IC) Details

View Information Collection (IC)

Attachment D – Patient Experience Survey_Data collection instrument
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 Patient experience survey Attachment D_Patient Experience Survey_Data collection instrument_20170727.docx No   Paper Only

Health Health Care Services

 

1,800 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,800 0 1,800 0 0 0
Annual IC Time Burden (Hours) 666 0 666 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment C – Patient Experience Survey_Cover letter and reminder notice Attachment C_Patient Experience Survey_Cover letter and reminder notice_20170727.docx 07/28/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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