Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey Comparative Database

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 Attachment F: Data Submission Secure Web Site and Information Collection Forms	Form and Instruction	Modified	Available
Form 2 Attachment B: Clinician and Group Database Data Use Agreement	Form and Instruction	Modified	Available
Form 1 Attachment A: Clinician and Group Data Submission System Registration Form	Form and Instruction	Modified	Available
Attachment F Data Submission Secure Web Site and Information Collection Forms.doc	Supplementary Document	Uploaded 2018-10-10	Available
Attachment E Submission Emails.doc	Supplementary Document	Uploaded 2018-10-10	Available
Attachment D CAHPS Database Technical Expert Panel Members.doc	Supplementary Document	Uploaded 2018-10-10	Available
Supporting Statement Part B -- CAHPS Clinician & Group Survey Database.doc	Supporting Statement B	Uploaded 2018-10-10	Available
Supporting Statement Part A -- CAHPS Clinician Group Survey Database (2).docx	Supporting Statement A	Uploaded 2018-10-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201283	Data Submission	Form and Instruction	Modified	Attachment F: Data Submission Secure Web Site and Information Collection Forms
201282	Data Agreement	Form and Instruction	Modified	Attachment B: Clinician and Group Database Data Use Agreement
201281	Registration Form	Form and Instruction	Modified	Attachment A: Clinician and Group Data Submission System Registration Form

ICR Details

OMB Control No: 0935-0197	ICR Reference No: 201810-0935-001
Status: Historical Active	Previous ICR Reference No: 201510-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey Comparative Database
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/21/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/11/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2022	36 Months From Approved	03/31/2019
Responses	207	0	700
Time Burden (Hours)	133	0	454
Cost Burden (Dollars)	0	0	0

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Abstract: The Agency for Healthcare Research and Quality (AHRQ) requests that the Office of Management and Budget (OMB) approve, under the Paperwork Reduction Act of 1995, AHRQ's collection of information for the AHRQ Consumer Assessment of Healthcare Providers and Systems (CAHPS) Database for Clinicians and Groups. The CAHPS Clinician and Group Database (CAHPS CG Database) consists of data from the AHRQ CAHPS Clinician and Group Survey (CAHPS CG Survey). Health systems administrators, medical groups and medical practitioners in the U.S. are asked to voluntarily submit data from the CAHPS CG Survey to AHRQ, through its contractor.

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Authorizing Statute(s): 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:
	83 FR 32872	07/16/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 50094	10/04/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Data Agreement	2	Attachment B: Clinician and Group Database Data Use Agreement
Data Submission	3	Attachment F: Data Submission Secure Web Site and Information Collection Forms
Registration Form	1	Attachment A: Clinician and Group Data Submission System Registration 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	207	700	0	-493	0	0
Annual Time Burden (Hours)	133	454	0	-321	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is a change in the hour burden due to a significant decrease in the volume of data submissions.

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Annual Cost to Federal Government: $251,000

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: 10/11/2018

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