Information Collection

Mapping and Questionnaire Documents IA 30812 A0 (AHRQ)

IC 235341 under ICR 201805-1090-003 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AHRQ USPSTF Q'aire Mapping and Questionnaire Documents IA 30812 A0 (AHRQ)	Form and Instruction
AHRQ USPSTF Q'aire AHRQ USPSTF Q'aire 7-30-15_DOT AHRQ USPSTF Q'aire 7-30-15_DOT.xlsx	Form and Instruction
Q_AHRQEnterprise_W Q_AHRQEnterprise_Web_Browse_20180117_DOT Q_AHRQEnterprise_Web_Browse_20180117_DOT.xlsx	Form and Instruction
1090-0008 Survey Mapping Document (AHRQ) IA 30812 A0_draft.xlsx 1090-0008 Survey Mapping Document (AHRQ) IA 30812 A0_draft	IC Document
Q_AHRQEnterprise_Web_Browse_20180117_DOT.xlsx AHRQ OMB Form 11.13.2018 IA 30812 A0	IC Document

IC Title:

Mapping and Questionnaire Documents IA 30812 A0 (AHRQ)

Agency IC Tracking Number:

30812 A0 (AHRQ)

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	AHRQ USPSTF Q'aire 7-30-15_DOT	AHRQ USPSTF Q'aire 7-30-15_DOT	AHRQ USPSTF Q'aire 7-30-15_DOT.xlsx		Yes	Yes	Fillable Fileable
Form and Instruction	Q_AHRQEnterprise_Web_Browse_20180117_DOT	Q_AHRQEnterprise_Web_Browse_20180117_DOT	Q_AHRQEnterprise_Web_Browse_20180117_DOT.xlsx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	3,600	3,600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1090-0008 Survey Mapping Document (AHRQ) IA 30812 A0_draft	1090-0008 Survey Mapping Document (AHRQ) IA 30812 A0_draft.xlsx	03/14/2019
AHRQ OMB Form 11.13.2018 IA 30812 A0	Q_AHRQEnterprise_Web_Browse_20180117_DOT.xlsx	03/14/2019

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