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
DocumentTypeStatusAvailability
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 Repair queued
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
IC IDCollectionTypeStatusForm
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
StatusReceived in OIRA
Agency/SubagencyHHS/AHRQ
OMB Control No0935-0124
Type of Information CollectionExtension without change of a currently approved collection
Previous ICR Reference No202009-0935-003
Agency Tracking No3rw3t
Date Submitted to OIRA1969-12-31
Requested Expiration Date1969-12-31