Information Collection Request

Collection of Information for Agency for Healthcare Research and Qualitys (AHRQ) Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey Comparative Database

ICR 202004-0935-001 · OMB 0935-0165 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #4 Data Files Submission Form and Instruction Modified Available
Form Form #3 Health Plan Information Form and Instruction Modified Available
Form Form #2 Data Use Agreement Form and Instruction Modified Available
Form 1 Registration Form and Data Submission Form and Instruction Modified Available
Supporting Statement Part B.docx Supporting Statement B Uploaded 2020-04-09 Available
Attachment F -- Submission Emails.pdf Supplementary Document Uploaded 2020-04-10 Available
Supporting Statement Part A - eb4-16-2020.docx Supporting Statement A Uploaded 2020-04-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
209485 Data Files Submission Form and Instruction Modified
192647 Health Plan Information Form and Instruction Modified
192646 Data Use Agreement Form and Instruction Modified
192645 Registration Form and Data Submission Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2023 36 Months From Approved 11/30/2020
760 0 800
463 0 501
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Registration Form and Data Submission 1 Attachment D: Registration Form
Data Use Agreement Form #2 Data Use Agreement
Health Plan Information Form #3 Health Plan Submission
Data Files Submission Form #4 Screen Shots of Data Submission

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 760 800 0 -40 0 0
Annual Time Burden (Hours) 463 501 0 -38 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No