Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) Survey Database

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 Attachment E: Submission Emails	Form and Instruction	New	Available
Form 3 Attachment D: Hospital Information Submission Form	Form and Instruction	New	Available
Form 2 Attachment B: Child HCAHPS Database Data Use Agreement	Form and Instruction	New	Available
Form 1 Attachment A: Child HCAHPS Registration Form	Form and Instruction	New	Available
Child HCAHPS Database_OMB Statement A_updated 9-21-18 clean (2).docx	Supporting Statement A	Uploaded 2019-03-22	Available
Response to your comment on Child HCAHPS database.msg	Supplementary Document	Uploaded 2019-03-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
235459	Attachment E: Submission Emails	Form and Instruction	New
235458	Attachment D: Hospital Information Submission Form	Form and Instruction	New
235457	Attachment B: Child HCAHPS Database Data Use Agreement	Form and Instruction	New
235456	Attachment A: Child HCAHPS Registration Form	Form and Instruction	New

ICR Details

OMB Control No: 0935-0243	ICR Reference No: 201903-0935-002
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) Survey Database
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/24/2019
	Date Received in OIRA: 03/25/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	36 Months From Approved
Responses	1,200	0	0
Time Burden (Hours)	365	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Child Hospital CAHPS Survey (Child HCAHPS) assesses the experiences of pediatric patients (less than 18 years old) and their parents or guardians with inpatient care. It complements the Adult Hospital CAHPS Survey (Adult HCAHPS), which asks adult inpatients about their experiences. In contrast to the adult version of HCAHPS, there is no publicly available comprehensive database for Child HCAHPS that allows survey users to analyze and compare their survey results in order to assess their performance and identify opportunities for improvement. The proposed Child HCAHPS Database will fill this critical information gap by creating a voluntary database available to all Child HCAHPS users to support both quality improvement and research to enhance the patient-centeredness of care delivered to pediatric hospital patients. AHRQ supported the development of the Child HCAHPS survey by the Center of Excellence for Pediatric Quality Measurement at Boston Children’s Hospital. The Child HCAHPS survey is currently used by approximately 300 hospitals. Hospitals using Child HCAHPS, including the 25 hospital members of the Pediatric Patient Experience Collaborative, have expressed strong interest in working with AHRQ to develop a database that can provide a centralized repository of data. Rationale for the information collection. Like the survey instrument itself and related toolkit materials to support survey implementation, the Child HCAHPS Database results will be made publicly available on AHRQ’s CAHPS website. Technical assistance will be provided by AHRQ through its contractor at no charge to hospitals to facilitate the access and use of these materials for quality improvement and research. Technical assistance will also be provided to support Child HCAHPS data submission.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Agency for 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 55717	11/07/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 10083	03/19/2019
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Attachment A: Child HCAHPS Registration Form	1	Attachment A: Child HCAHPS Registration Form
Attachment B: Child HCAHPS Database Data Use Agreement	2	Attachment B: Child HCAHPS Database Data Use Agreement
Attachment D: Hospital Information Submission Form	3	Attachment D: Hospital Information Submission Form
Attachment E: Submission Emails	4	Attachment E: Submission Emails

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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	1,200	0	0	1,200	0	0
Annual Time Burden (Hours)	365	0	0	365	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: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $254,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 03/25/2019

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