Information Collection

Agency for Healthcare Research and Quality (AHRQ) COVID-19 Primary Care Learning Community Participant Survey

IC 250559 under ICR 202310-0935-001 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Agency for Healthcare Research and Quality (AHRQ) COVID-19 Primary Care Learning Community Participant Survey	Form and Instruction
1 PCLC Survey PCLC survey (002).docx	Form and Instruction
1 PCLC Survey PCLC survey (002).docx	Form and Instruction
OMB Cover Letter.docx Cover Letter	IC Document
OMB Cover Letter.docx Cover Letter	IC Document
Fast Track PC LC participant survey eb11172021.docx Supporting Statement	IC Document
Fast Track PC LC participant survey eb11172021.docx Supporting Statement	IC Document

IC Title:

Agency for Healthcare Research and Quality (AHRQ) COVID-19 Primary Care Learning Community Participant Survey

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	PCLC Survey	PCLC survey (002).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 285

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	285	285
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Letter	OMB Cover Letter.docx	11/29/2021
Supporting Statement	Fast Track PC LC participant survey eb11172021.docx	11/29/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.