SUBMISSION OF INFORMATION COLLECTION UNDER THE
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: OMB Number 0935-0179
DATE OF REQUEST: April 27, 2018
SUB AGENCY (I/C): HHS/AHRQ
TITLE: Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey
GENERIC CLEARANCE UNDER OMB#: 0935-0179 EXP. DATE: 11/30/2020
In
order to assess the effectiveness of the CAHPS and SOPS technical
assistance that Westat provides, Westat will ask those that receive
technical assistance to complete a brief web-based questionnaire.
The feedback will allow Westat to evaluate its performance in
meeting user needs and to identify ways to improve its customer
service. Westat will ask all users who contact the CAHPS technical
assistance mailbox ([email protected]) and the SOPS technical
assistance mailbox ([email protected])
to complete a brief web based questionnaire hosted on SurveyMonkey.
SurveyMonkey was chosen because it allows for free, easy to use and
secure web-based administration. The questionnaire addresses user
experience with obtaining timely and useful technical assistance. Organizations
that download MONAHRQ and generate reports to help improve health
care are referred to as “Host Users.” The Future of
MONAHRQ Survey 2014 will be accessible to current and prospective
Host Users. Examples of Host Users include: state agencies, public
health departments, hospital associations, hospital systems, and
individual hospitals, multi-stakeholder alliances and coalitions,
Quality Improvement Organizations (QIOs), and health plans.
TOTAL ANNUAL BURDEN APPROVED: 3,383 Hours Per year
BURDEN USED TO DATE: 574 hours.
BURDEN THIS REQUEST: 50 hours.
FEDERAL COST: The estimated annual cost to the Federal government is $XXX.00
IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?
______YES ______ NO _____x_ N/A
OBLIGATION TO RESPOND:
___x___ VOLUNTARY
______ REQUIRED TO OBTAIN OR RETAIN BENEFITS
______ MANDATORY
HOW WILL THIS SURVEY BE OFFERED?
__x___ WEB SITE
_____ TELEPHONE INTERVIEW
_____ MAIL RESPONSE
_____ IN PERSON INTERVIEW
_____ OTHER: ___________________________________
CONTACT INFORMATION:
NAME: _Erwin Brown______________________________
TELEPHONE NUMBER: 301.427.1652________________
EMAIL ADDRESS: [email protected]________________
| File Type | application/msword |
| File Title | Generic Clearance Form - 04/28/2008 |
| Subject | Generic Clearance Form - 04/28/2008 |
| Author | OD/USER |
| Last Modified By | SYSTEM |
| File Modified | 2018-05-04 |
| File Created | 2018-05-04 |