Pilot Test of the Protocol for Eliciting Patient Narratives from Parents for the Child Hospital Consumer Assessment of Healthcare

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0124 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Pilot Test of the Protocol for Eliciting Patient Narratives from Parents for the Child Hospital Consumer Assessment of Healthcare Form and Instruction
1 Attachment B Child HCAHPS Survey 2019-03-11.docx Attachment B Child HCAHPS Survey 2018-11-28.docx Form and Instruction
2 Attachment D Intensive interview protocol 2019-03-11.doc Attachment D Intensive Interview Protocol 2018-12-10.docx Form and Instruction
OMB Cover Letter.doc Cover Letter IC Document
Attachment A Child HCAHPS NEP Invitation 2019-03-11.docx Attachment A Child HCAHPS NEP Invitation 2019-03-11.docx IC Document
Attachment C Child HCAHPS Narrative Elicitation Protocol 2019-03-11.docx Attachment C Child HCAHPS Narrative Elicitation Protocol 2019-03-11.docx IC Document
Attachment E Informed Consent 2019-03-11.docx Attachment E Informed consent 2019-03-11.docx IC Document
DRAFT CAHPS NEP OMB Statement A 2019-03-11 (003).doc Supporting Statement Part A 2019-03-11 IC Document
DRAFT CAHPS NEP OMB Statement B 2019-03-11.doc Supporting Statement Part B IC Document
DRAFT CAHPS NEP OMB Statement A 2019-07-18.doc Supporting Statement A IC Document

Information Collection (IC) Details

IC Title:	Pilot Test of the Protocol for Eliciting Patient Narratives from Parents for the Child Hospital Consumer Assessment of Healthcare	Agency IC Tracking Number:

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	Attachment B Child HCAHPS Survey 2019-03-11.docx	Attachment B Child HCAHPS Survey 2018-11-28.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Attachment D Intensive interview protocol 2019-03-11.docx	Attachment D Intensive Interview Protocol 2018-12-10.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cover Letter	OMB Cover Letter.doc	03/26/2019
Attachment A Child HCAHPS NEP Invitation 2019-03-11.docx	Attachment A Child HCAHPS NEP Invitation 2019-03-11.docx	03/26/2019
Attachment C Child HCAHPS Narrative Elicitation Protocol 2019-03-11.docx	Attachment C Child HCAHPS Narrative Elicitation Protocol 2019-03-11.docx	03/26/2019
Attachment E Informed consent 2019-03-11.docx	Attachment E Informed Consent 2019-03-11.docx	03/26/2019
Supporting Statement Part A 2019-03-11	DRAFT CAHPS NEP OMB Statement A 2019-03-11 (003).doc	03/26/2019
Supporting Statement Part B	DRAFT CAHPS NEP OMB Statement B 2019-03-11.doc	03/26/2019
Supporting Statement A	DRAFT CAHPS NEP OMB Statement A 2019-07-18.doc	08/07/2019

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