Information Collection Request

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

ICR 202401-0935-006 · OMB 0935-0124 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
Document	Type	Status	Availability
Form 1 Provider Focus Group	Form and Instruction	Unchanged	Repair queued
Form 1 Provider and Patient Interview	Form and Instruction	Unchanged	Repair queued
Form 1 Patient and Caregiver Usability Interview	Form and Instruction	Unchanged	Repair queued
Form 1 Patient and Caregiver Survey	Form and Instruction	Unchanged	Repair queued
Form 1 MEPS Alternative Sampling Design Pilot Test	Form and Instruction	Unchanged	Repair queued
Form 1B Feasibility Study for a MEPS Monthly Check-In	Form and Instruction	Unchanged	Repair queued
Form 1 Pilot Test of the Proposed Workplace Safety Supplemental Item Set For the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey	Form and Instruction	Unchanged	Available
Form 1 Field Test of A Survey of End-of-Life Care	Form and Instruction	Unchanged	Repair queued
Form 1 Pilot Test of the Revised Data Collection Method for the Medical Expenditure Panel Survey - Insurance Component	Form and Instruction	Unchanged	Repair queued
Attachment D - Generic Clearance Submission.docx	Supplementary Document	Uploaded 2024-01-25	Repair queued
Attachment B - Data Collections under Generic 0935-0124.docx	Supplementary Document	Uploaded 2024-01-25	Repair queued
Attachment A - Healthcare Research and Quality Act of 1999.pdf	Supplementary Document	Uploaded 2024-01-25	Repair queued
Supporting Statement Part B - Generic 0935-0124 Questionnaire and Data Collection Testing, Evaluation and Research.docx	Supporting Statement B	Uploaded 2024-01-25	Repair queued
Supporting Statement Part A - Generic 0935-0124 Questionnaire and Data Collection Testing Evaluation and Research_012524.docx	Supporting Statement A	Uploaded 2024-01-25	Repair queued

IC Document Collections

Information collection document groups
IC ID	Collection	Type	Status
263760	Provider Focus Group	Form and Instruction	Unchanged
263759	Provider and Patient Interview	Form and Instruction	Unchanged
263758	Patient and Caregiver Usability Interview	Form and Instruction	Unchanged
263757	Patient and Caregiver Survey	Form and Instruction	Unchanged
252822	MEPS Alternative Sampling Design Pilot Test	Form and Instruction	Unchanged
251475	Feasibility Study for a MEPS Monthly Check-In	Form and Instruction	Unchanged
251418	Pilot Test of the Proposed Workplace Safety Supplemental Item Set For the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey	Form and Instruction	Unchanged
249349	Field Test of A Survey of End-of-Life Care	Form and Instruction	Unchanged
246524	Pilot Test of the Revised Data Collection Method for the Medical Expenditure Panel Survey - Insurance Component	Form and Instruction	Unchanged

ICR Details

Record metadata
Status	Received in OIRA
Agency/Subagency	HHS/AHRQ
OMB Control No	0935-0124
Type of Information Collection	Extension without change of a currently approved collection
Previous ICR Reference No	202009-0935-003
Agency Tracking No	3rw3t
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31