Information Collection Request

Use of Open-Ended Responses to Explore Disparities in Patient Experience

ICR 202309-0935-001 · OMB 0935-0266 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #1 Use of Narrative Data to Explore Disparities in Patient Experience Form and Instruction New Repair queued
SS Part A -- Use of Open-Ended Responses to Explore Disparities in Patient Experience.docx Supporting Statement A Uploaded 2023-09-19 Repair queued
Attachment D Ipsos Confidentiality Agreement 021023.docx Supplementary Document Uploaded 2023-09-15 Repair queued
Attachment C Informed Consent 042523.docx Supplementary Document Uploaded 2023-09-15 Repair queued
Attachment A CG-CAHPS NEP Invitation 042523.docx Supplementary Document Uploaded 2023-09-15 Repair queued
SS Part B -- Use of Open-Ended Responses to Explore Disparities in Patient Experience.docx Supporting Statement B Uploaded 2023-09-15 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
262196 Use of Narrative Data to Explore Disparities in Patient Experience Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
4,998 0
1,416 0
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Use of Narrative Data to Explore Disparities in Patient Experience Form #1 Survey Instrument

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,998 0 0 4,998 0 0
Annual Time Burden (Hours) 1,416 0 0 1,416 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No