Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality – Marketplaces and Exchanges

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

OMB: 0935-0124

IC ID: 234711

Information Collection (IC) Details

View Information Collection (IC)

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality – Marketplaces and Exchanges
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3 Attachment G – Interview Protocol Attachment G – Interview Guide Marketplaces_ExchangesV1.docx No   Paper Only
Form and Instruction 1 Initial Screening Attachment A Initial Screening Questionnaire Private Ins.docx Yes Yes Fillable Fileable
Form and Instruction 2 In Depth Screening Attachment B In-depth Screening Questionnaire Private Ins.docx Yes Yes Fillable Fileable

Health Health Care Services

 

245 0
   
Individuals or Households
 
   75 %

  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 245 0 245 0 0 0
Annual IC Time Burden (Hours) 28 0 28 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letter OMB Cover Letter.doc 01/11/2019
Attachment C - Informational Letter for Participants Attachment C - Informational Letter for Participants Marketplaces_Exchanges.docx 01/11/2019
Attachment D – Participant Consent Form Attachment D – Participant Consent Form Marketplaces_Exchanges.docx 01/11/2019
Attachment E – Directions to Econometrica Facility Attachment E – Directions to Econometrica Facility Marketplaces_Exchanges.docx 01/11/2019
Attachment F – Checklist and Directions for Gathering Requested Documents Attachment F – Checklist and Directions for Gathering Requested Documents Marketplaces_Exchanges.docx 01/11/2019
Supporting Statement A Health Policy Booklets Marketplaces_Exchanges Supporting Statement A Health Policy Booklets Marketplaces_Exchanges 031119.docx 04/08/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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