Information Collection Request

The AHRQ Safety Program for Telemedicine: Improving the Diagnostic Process and Improving Antibiotic Use

ICR 202303-0935-001 · OMB 0935-0265 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0935-0265 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form 11 Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort	Form and Instruction	New	Repair queued
Form 10 Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort	Form and Instruction	New	Missing upstream
Form 8 Interview Guide for Semi-Structured Interviews	Form and Instruction	New	Repair queued
Form 7 Participant Experience Survey_Antibiotic Stewardship Cohort	Form and Instruction	New	Repair queued
Form 6 Participant Experience Survey_Cancer Diagnostic Process Cohort	Form and Instruction	New	Repair queued
Form 5 Diagnostic Safety Supplement	Form and Instruction	New	Repair queued
Form 4 The Medical Office Survey on Patient Safety Culture (MOSOPS)	Form and Instruction	New	Repair queued
Form 3 The Office Readiness Survey_Cancer Diagnostic Process Cohort	Form and Instruction	New	Repair queued
Form 1 Structural Assessments	Form and Instruction	New	Repair queued
Supporting Statement A.docx	Supporting Statement A	Uploaded 2023-03-16	Missing upstream
Att N_Schedule of Assessment Activities, 2022-2026.docx	Supplementary Document	Uploaded 2023-03-09	Repair queued
Supporting Statement B .docx	Supporting Statement B	Uploaded 2023-03-06	Repair queued

IC Document Collections

IC ID	Collection	Type	Status
258926	Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort	Form and Instruction	New
258925	Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort	Form and Instruction	New
258922	Interview Guide for Semi-Structured Interviews	Form and Instruction	New
258921	Participant Experience Survey_Antibiotic Stewardship Cohort	Form and Instruction	New
258920	Participant Experience Survey_Cancer Diagnostic Process Cohort	Form and Instruction	New
258919	Diagnostic Safety Supplement	Form and Instruction	New
258916	The Medical Office Survey on Patient Safety Culture (MOSOPS)	Form and Instruction	New
258915	The Office Readiness Survey_Cancer Diagnostic Process Cohort	Form and Instruction	New
258913	Structural Assessments	Form and Instruction	New

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/AHRQ
OMB Control No	0935-0265
Type of Information Collection	New collection (Request for a new OMB Control Number)
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31