Structural Assessments

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1 Structural Assessments Form and Instruction
1 Attachment A: Structural Assessment_Cancer Diagnostic Pr Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx Form and Instruction
1 Attachment A: Structural Assessment_Cancer Diagnostic Pr Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx Form and Instruction
2 Attachment B: Structural Assessment_Antibiotic Stewardsh Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx Form and Instruction
2 Attachment B: Structural Assessment_Antibiotic Stewardsh Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx Form and Instruction
Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx Structural Assessment_Cancer Diagnostic Process Cohort IC Document
Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx Structural Assessment_Cancer Diagnostic Process Cohort IC Document
Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx Structural Assessment_Antibiotic Stewardship Cohort IC Document
Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx Structural Assessment_Antibiotic Stewardship Cohort IC Document

Information Collection (IC) Details

IC Title:	Structural Assessments	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Attachment A: Structural Assessment_Cancer Diagnostic Process Cohort	Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Attachment B: Structural Assessment_Antibiotic Stewardship Cohort	Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Structural Assessment_Cancer Diagnostic Process Cohort	Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx	03/06/2023
Structural Assessment_Antibiotic Stewardship Cohort	Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx	03/06/2023

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