Information Collection

Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey

IC 231422 under ICR 202009-0935-002 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey	Form and Instruction
1 2018 AHRQ QI SURVEY AHRQ QI Survey - Screen shots - Final.pdf	Form and Instruction
OMB Cover Letter_FINAL MD5.09.18.doc Cover Letter	IC Document
OMB Clearance Attachment B Submission Form AHRQ QI survey_FINALMD_5.09.2018.docx Supporting Statement	IC Document

IC Title:

Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey

Agency IC Tracking Number:

IC Status: Unchanged

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	1	2018 AHRQ QI SURVEY	AHRQ QI Survey - Screen shots - Final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Letter	OMB Cover Letter_FINAL MD5.09.18.doc	05/10/2018
Supporting Statement	OMB Clearance Attachment B Submission Form AHRQ QI survey_FINALMD_5.09.2018.docx	05/10/2018

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