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: Patient Interview Guide
GENERIC CLEARANCE UNDER OMB#: 0935-0179 EXP. DATE: 11/30/2020
Providers noted that data
from a PRO app would be most useful when the PRO data are likely to
have clinical significance and can guide treatment of the patient.
As interviews will be conducted following app usage, only patients
who have completed the app will be eligible to participate in
patient interviews.
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 $219.06_.
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: Interview_
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 | 2018-10-29 |
| File Created | 2018-10-29 |