SUBMISSION OF INFORMATION COLLECTION UNDER THE
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
DATE OF REQUEST: October 18, 2018
SUB AGENCY (I/C): HHS/AHRQ
TITLE: Readiness for Change Assessment
GENERIC CLEARANCE UNDER OMB#: 0935-0179 EXP. DATE: 11/30/2020
From a general practice
perspective, we seek to understand at baseline, the various factors
which may impact implementation and use of the app and PRO data at
an organizational level. Organizational readiness for change in
healthcare settings is a key factor in successful implementation of
new policies, programs, and practice. To provide an overall
indication of the likelihood of success as well as context for
evaluation findings, all participating sites will complete a
paper-based baseline organizational readiness for change
assessment.
TOTAL ANNUAL BURDEN APPROVED: 3,383 Hours Per year
BURDEN USED TO DATE: 404 hours.
BURDEN THIS REQUEST: 9 hours.
FEDERAL COST: The estimated annual cost to the Federal government is $349_.
IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?
______YES ______ NO _____x_ N/A
OBLIGATION TO RESPOND:
___x___ VOLUNTARY
______ REQUIRED TO OBTAIN OR RETAIN BENEFITS
______ MANDATORY
HOW WILL THIS SURVEY BE OFFERED?
____ WEB SITE
____ TELEPHONE INTERVIEW
_____ MAIL RESPONSE
_____ IN PERSON INTERVIEW
__x___ OTHER: __ Paper-based survey provided to site champions
CONTACT INFORMATION:
NAME: _Erwin Brown______________________________
TELEPHONE NUMBER: 301.427.1652________________
EMAIL ADDRESS: [email protected]________________
| File Type | application/msword |
| File Title | Generic Clearance Form - 04/28/2008 |
| Subject | Generic Clearance Form - 04/28/2008 |
| Author | OD/USER |
| Last Modified By | SYSTEM |
| File Modified | 2018-10-29 |
| File Created | 2018-10-29 |