Data Use Agreement

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

Documents and Forms

Document Name Document Type
Form Form #2 Data Use Agreement Form and Instruction
Form #2 Data Use Agreement Attachment B -- Data Use Agreement Form.pdf Form and Instruction
Form #2 Data Use Agreement Attachment B -- Data Use Agreement Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Data Use Agreement	Agency IC Tracking Number:

Is this a Common Form? No		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	Form #2	Data Use Agreement	Attachment B -- Data Use Agreement Form.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	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: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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