Cover Letter

SUBMISSION OF INFORMATION COLLECTION UNDER THE

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

DATE OF REQUEST: 11.29.2021

SUB AGENCY (I/C): HHS/AHRQ

TITLE: Administration of “Use of Agency for Healthcare Research and Quality (AHRQ) Tools to Measure Aspects of Patient Safety” Questionnaire to AHRQ SOPS® Listserv Subscribers

GENERIC CLEARANCE UNDER OMB#: 0935-0179 EXP. DATE: 11/30/2023

The AHRQ Surveys on Patient Safety Culture™ (SOPS®) program is composed of a set of surveys designed to ask healthcare providers and other staff in hospitals, medical offices, nursing homes, community pharmacies, and ambulatory surgery centers about their perceptions of their organizational culture’s support for patient safety. AHRQ is seeking input via a brief questionnaire of multiple constituencies that are connected to, or engaged with, the SOPS program to assess their awareness of AHRQ tools that assess safer patient environment in healthcare settings. Specifically, AHRQ would like to learn whether these constituencies recognize and/or are familiar with AHRQ SOPS surveys about patient safety culture, compared to knowledge of other similar products.

ABSTRACT:

TOTAL ANNUAL BURDEN APPROVED: 3,383 Hours Per year

BURDEN USED TO DATE: 1687 hours.

BURDEN THIS REQUEST: 125 hours.

FEDERAL COST: The estimated annual cost to the Federal government is $3,300.00_____.

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]________________