Information Collection

Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract

IC 241698 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⚠️ Notice: This information collection may be referencing outdated material.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 Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract	Form and Instruction
1 Appendix A Appendix A.docx	Form and Instruction
2 Appendix B Appendix B.docx	Form and Instruction
3 Appendix C Appendix C.docx	Form and Instruction
4 Appendix D Appendix D.docx	Form and Instruction
5 Appendix E Appendix E.docx	Form and Instruction
6 Appendix F Appendix F.docx	Form and Instruction
7 Appendix Appendix G.docx	Form and Instruction
Fast Track Template_4.21.20_final draft v3.docx Supporting Statement	IC Document
Supporting Statement Detailed.docx Detailed Supporting Statement	IC Document
OMB Cover Letter (4).docx Cover Letter	IC Document

IC Title:

Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract

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	Available Electronically?	Electronic Capability
Form and Instruction	1	Appendix A	Appendix A.docx	No	Paper Only
Form and Instruction	2	Appendix B	Appendix B.docx	No	Paper Only
Form and Instruction	3	Appendix C	Appendix C.docx	No	Paper Only
Form and Instruction	4	Appendix D	Appendix D.docx	No	Paper Only
Form and Instruction	5	Appendix E	Appendix E.docx	No	Paper Only
Form and Instruction	6	Appendix F	Appendix F.docx	No	Paper Only
Form and Instruction	7	Appendix	Appendix G.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 680

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	680	680
Annual IC Time Burden (Hours)	565	565
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Fast Track Template_4.21.20_final draft v3.docx	05/05/2020
Detailed Supporting Statement	Supporting Statement Detailed.docx	05/05/2020
Cover Letter	OMB Cover Letter (4).docx	05/05/2020

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