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Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

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OMB: 0935-0179

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SUBMISSION OF INFORMATION COLLECTION UNDER THE

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery


DATE OF REQUEST: October 18, 2018


SUB AGENCY (I/C): HHS/AHRQ


TITLE: Readiness for Change Assessment


GENERIC CLEARANCE UNDER OMB#: 0935-0179 EXP. DATE: 11/30/2020


ABSTRACT:

From a general practice perspective, we seek to understand at baseline, the various factors which may impact implementation and use of the app and PRO data at an organizational level. Organizational readiness for change in healthcare settings is a key factor in successful implementation of new policies, programs, and practice. To provide an overall indication of the likelihood of success as well as context for evaluation findings, all participating sites will complete a paper-based baseline organizational readiness for change assessment.












TOTAL ANNUAL BURDEN APPROVED: 3,383 Hours Per year

BURDEN USED TO DATE: 404 hours.

BURDEN THIS REQUEST: 9 hours.


FEDERAL COST: The estimated annual cost to the Federal government is $349_.


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?

­____ WEB SITE

____ TELEPHONE INTERVIEW

_____ MAIL RESPONSE

_____ IN PERSON INTERVIEW

__x___ OTHER: __ Paper-based survey provided to site champions

CONTACT INFORMATION:

NAME: _Erwin Brown______________________________

TELEPHONE NUMBER: 301.427.1652________________

EMAIL ADDRESS: [email protected]________________

File Typeapplication/msword
File TitleGeneric Clearance Form - 04/28/2008
SubjectGeneric Clearance Form - 04/28/2008
AuthorOD/USER
Last Modified BySYSTEM
File Modified2018-10-29
File Created2018-10-29

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