Information Collection Request

Collection of Information for Agency for Healthcare Research and Qualitys (AHRQ) Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey Comparative Database

ICR 202310-0935-003 · OMB 0935-0165 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #4 Screen Shots of Data Submission Form and Instruction Unchanged Available
Form Form #4 Data Files Submission Form and Instruction Unchanged Repair queued
Form Form #3 Health Plan Submission Form and Instruction Unchanged Repair queued
Form Form #3 Health Plan Information Form and Instruction Unchanged Repair queued
Form Form #2 Data Use Agreement Form and Instruction Unchanged Available
Form Form #2 Data Use Agreement Form and Instruction Unchanged Repair queued
Form 1 Attachment D: Registration Form Form and Instruction Unchanged Available
Form 1 Registration Form and Data Submission Form and Instruction Unchanged Repair queued
Attachment E -- Data Submission Screenshots.pdf Supplementary Document Uploaded 2023-10-30 Repair queued
SS Part A -- Collection of Information for CAHPS Health Plan Survey Database _10-30-2023.docx Supporting Statement A Uploaded 2023-10-30 Repair queued
SS Part B -- Collection of Information for CAHPS_10-24-2023.docx Supporting Statement B Uploaded 2023-10-26 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
209485 Data Files Submission Form and Instruction UnchangedScreen Shots of Data Submission
209485 Data Files Submission Form and Instruction Unchanged
192647 Health Plan Information Form and Instruction UnchangedHealth Plan Submission
192647 Health Plan Information Form and Instruction Unchanged
192646 Data Use Agreement Form and Instruction UnchangedData Use Agreement
192646 Data Use Agreement Form and Instruction Unchanged
192645 Registration Form and Data Submission Form and Instruction UnchangedAttachment D: Registration Form
192645 Registration Form and Data Submission Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2026 36 Months From Approved 12/31/2023
760 0 760
463 0 463
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Data Files Submission Form #4
Data Use Agreement Form #2
Health Plan Information Form #3
Registration Form and Data Submission 1

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 760 760 0 0 0 0
Annual Time Burden (Hours) 463 463 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No