Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Return on Investment of AHRQ's Individual Career Development (K) Award Program Evaluation	Form and Instruction	Unchanged	Available
Form 1 National Guideline Clearinghouse - National Quality Measures Clearinghouse	Form and Instruction	Unchanged	Available
Supporting Statement Part B -- Customer Survey Generic Clearance 2014.doc	Supporting Statement B	Uploaded 2014-09-05	Repair queued
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document	Uploaded 2011-04-04	Available
Attachment B -- Examples.doc	Supplementary Document	Uploaded 2011-04-04	Available
Supporting Statement Part A -Customer Survey Generic Clearance 2017.doc	Supporting Statement A	Uploaded 2017-09-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214829	Return on Investment of AHRQ's Individual Career Development (K) Award Program Evaluation	Form and Instruction	Unchanged
214022	National Guideline Clearinghouse - National Quality Measures Clearinghouse	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0935-0106	ICR Reference No: 201709-0935-003
Status: Historical Active	Previous ICR Reference No: 201409-0935-003
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Voluntary Customer Surveys Generic Clearance for the Agency for Healthcare Research and Quality
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/13/2017
	Date Received in OIRA: 09/26/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2020	36 Months From Approved	12/31/2017
Responses	10,900	0	10,900
Time Burden (Hours)	3,383	0	3,383
Cost Burden (Dollars)	0	0	0

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Abstract: Surveys will assess strengths and weaknesses of agency program services including querying individuals using AHRQ paper and electronic products to determine satisfaction with form and content or to assess effects of streamlining efforts.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Generic Customer Satisfaction Surveys
   US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 24704	05/30/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 43377	09/15/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Return on Investment of AHRQ's Individual Career Development (K) Award Program Evaluation	1	Questionnaire for the K Program Participants
National Guideline Clearinghouse - National Quality Measures Clearinghouse	1	Attachment C. Expert Commentary Response Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10,900	10,900	0	0	0	0
Annual Time Burden (Hours)	3,383	3,383	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $809,619

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/26/2017

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