Information Collection

Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract

IC 241698 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Form and Instruction
1 Appendix A Appendix A.docx Form and Instruction
2 Appendix B Appendix B.docx Form and Instruction
3 Appendix C Appendix C.docx Form and Instruction
4 Appendix D Appendix D.docx Form and Instruction
5 Appendix E Appendix E.docx Form and Instruction
6 Appendix F Appendix F.docx Form and Instruction
7 Appendix Appendix G.docx Form and Instruction
Fast Track Template_4.21.20_final draft v3.docx Supporting Statement IC Document
Supporting Statement Detailed.docx Detailed Supporting Statement IC Document
OMB Cover Letter (4).docx Cover Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	1	Appendix A	Appendix A.docx	No	Paper Only
Form and Instruction	2	Appendix B	Appendix B.docx	No	Paper Only
Form and Instruction	3	Appendix C	Appendix C.docx	No	Paper Only
Form and Instruction	4	Appendix D	Appendix D.docx	No	Paper Only
Form and Instruction	5	Appendix E	Appendix E.docx	No	Paper Only
Form and Instruction	6	Appendix F	Appendix F.docx	No	Paper Only
Form and Instruction	7	Appendix	Appendix G.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 680	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	680	680
Annual IC Time Burden (Hours)	565	565
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Fast Track Template_4.21.20_final draft v3.docx	05/05/2020
Detailed Supporting Statement	Supporting Statement Detailed.docx	05/05/2020
Cover Letter	OMB Cover Letter (4).docx	05/05/2020

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