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Information Collection

Use of Narrative Data to Explore Disparities in Patient Experience

IC 262196 under ICR 202309-0935-001 · OMB 0935-0266.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Use of Narrative Data to Explore Disparities in Patient Experience
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #1 Survey Instrument Attachment B Survey Instrument 042523.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

4,998 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,998 0 4,998 0 0 0
Annual IC Time Burden (Hours) 1,416 0 1,416 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CG-CAHPS NEP Invitation Attachment A CG-CAHPS NEP Invitation 042523.docx 09/15/2023
Informed Consent Attachment C Informed Consent 042523.docx 09/15/2023
Ipsos Confidentiality Agreement Attachment D Ipsos Confidentiality Agreement 021023.docx 09/15/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.