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 for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1 Administration of "Use of Agency for Healthcare Research and Quality (AHRQ) Tools to Measure Aspects of Patient Safety" Questionnaire to AHRQ SOPS® Listserv Subscribers Form and Instruction
Appendix A (Revised).docx Other-Instrument
Appendix A (Revised).docx Other-Instrument
1 Appendix A Appendix A.docx Form and Instruction
1 Appendix A Appendix A.docx Form and Instruction
OMB Cover Letter.docx Cover Letter IC Document
OMB Cover Letter.docx Cover Letter IC Document
Supporting Statement.docx Supporting Statement IC Document
Supporting Statement.docx Supporting Statement IC Document

Information Collection (IC) Details

IC 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	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Appendix A	Appendix A.docx		Yes	Yes	Fillable Fileable
Other-Instrument			Appendix A (Revised).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	133	133
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cover Letter	OMB Cover Letter.docx	11/29/2021
Supporting Statement	Supporting Statement.docx	11/29/2021

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