Information Collection

Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey

IC 231422 under ICR 201709-0935-001 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey	Form and Instruction
1 2018 AHRQ QI SURVEY AHRQ QI Survey - Screen shots - Final.pdf	Form and Instruction
OMB Cover Letter_FINAL MD5.09.18.doc Cover Letter	IC Document
OMB Clearance Attachment B Submission Form AHRQ QI survey_FINALMD_5.09.2018.docx Supporting Statement	IC Document

IC Title:

Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	2018 AHRQ QI SURVEY	AHRQ QI Survey - Screen shots - Final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Letter	OMB Cover Letter_FINAL MD5.09.18.doc	05/10/2018
Supporting Statement	OMB Clearance Attachment B Submission Form AHRQ QI survey_FINALMD_5.09.2018.docx	05/10/2018

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