Voluntary Customer Satisfaction Survey of AHRQ PSNet Users

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

Documents and Forms

Document Name Document Type
Form 1 Voluntary Customer Satisfaction Survey of AHRQ PSNet Users Form and Instruction
1 Usability Script Usability Scriptv2.docx Form and Instruction
1 Usability Script Usability Scriptv2.docx Form and Instruction
2 Web Screener Survey Web Screener Questionsv1.docx Form and Instruction
2 Web Screener Survey Web Screener Questionsv1.docx Form and Instruction
OMB Cover Letter.docx Cover Letter IC Document
OMB Cover Letter.docx Cover Letter IC Document
Submission Form-2022-PSNet_V2.docx Supporting Statement IC Document
Submission Form-2022-PSNet_V2.docx Supporting Statement IC Document
Usability Consent Form.docx Consent form IC Document
Usability Consent Form.docx Consent form IC Document

Information Collection (IC) Details

IC Title:	Voluntary Customer Satisfaction Survey of AHRQ PSNet Users	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	Usability Script	Usability Scriptv2.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Web Screener Survey	Web Screener Questionsv1.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 225	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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