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

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

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.