SUBMISSION OF INFORMATION COLLECTION UNDER THE
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
DATE OF REQUEST: October 4, 2017
SUB AGENCY (I/C): HHS/AHRQ
TITLE: Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
GENERIC CLEARANCE UNDER OMB#: 0925-0179 EXP. DATE: 11/30/2017
The mission of the EPC
program is to create reports that improve healthcare by supporting
evidence-based decision making by patients, providers, and
policymakers. To ensure that our reports answer the questions that
are important to patient, we invite 1-2 patients or patient
representatives as Key Informants to participate in designing the
research questions that guide the report. In order to be certain
our process effectively engages these patient Key Informants and to
make sure that the final report answers their questions, we would
like to ask them a few questions via an online tool about their
experience and about the final report, once the project is completed
and the final report has been posted. This information will be used
to improve how we work with patients going forward and to improve
the usefulness of our reports for patients. Organizations
that download MONAHRQ and generate reports to help improve health
care are referred to as “Host Users.” The Future of
MONAHRQ Survey 2014 will be accessible to current and prospective
Host Users. Examples of Host Users include: state agencies, public
health departments, hospital associations, hospital systems, and
individual hospitals, multi-stakeholder alliances and coalitions,
Quality Improvement Organizations (QIOs), and health plans.
TOTAL ANNUAL BURDEN APPROVED: 3,383 Hours Per year
BURDEN USED TO DATE: 404 hours.
BURDEN THIS REQUEST: 10 hours.
FEDERAL COST: The estimated annual cost to the Federal government is $600_____.
IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?
______YES ______ NO _____x_ N/A
OBLIGATION TO RESPOND:
___x___ VOLUNTARY
______ REQUIRED TO OBTAIN OR RETAIN BENEFITS
______ MANDATORY
HOW WILL THIS SURVEY BE OFFERED?
___x_ WEB SITE
___ _ TELEPHONE INTERVIEW
_____ MAIL RESPONSE
_____ IN PERSON INTERVIEW
_____ OTHER: ___________________________________
CONTACT INFORMATION:
NAME: _Erwin Brown______________________________
TELEPHONE NUMBER: 301.427.1652________________
EMAIL ADDRESS: [email protected]________________
| File Type | application/msword |
| File Title | Generic Clearance Form - 04/28/2008 |
| Subject | Generic Clearance Form - 04/28/2008 |
| Author | OD/USER |
| Last Modified By | SYSTEM |
| File Modified | 2017-11-07 |
| File Created | 2017-11-07 |