Information Collection

Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey

IC 231422 under ICR 202501-0935-001 · OMB 0935-0179.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey	Form and Instruction
Form 1 AHRQ QI Survey 2025 - Clean Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey	Form and Instruction
Form 2 AHRQ QI Survey 2025 - Track Changes Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey	Form and Instruction
1 AHRQ QI Survey 2025 - Clean AHRQ QI Survey 2025 - CLEAN.docx	Form and Instruction
1 AHRQ QI Survey 2025 - Clean AHRQ QI Survey 2025 - CLEAN.docx	Form and Instruction
2 AHRQ QI Survey 2025 - Track Changes AHRQ QI Survey 2025 - Track Changes.docx	Form and Instruction
2 AHRQ QI Survey 2025 - Track Changes AHRQ QI Survey 2025 - Track Changes.docx	Form and Instruction
2018 AHRQ QI Survey - Screen shots - Final.pdf 2018 AHRQ QI SURVEY	IC Document
2018 AHRQ QI Survey - Screen shots - Final.pdf 2018 AHRQ QI SURVEY	IC Document
Memo - Changes to the 2018 Survey 01152025.docx Memo - Changes to the 2018 Survey	IC Document
Memo - Changes to the 2018 Survey 01152025.docx Memo - Changes to the 2018 Survey	IC Document
Supporting Statement - Gen IC 0935-0179 AHRQ QI Customer Survey 2025.docx Supporting Statement - Gen IC 0935-0179 AHRQ QI Customer Survey 2025	IC Document
Supporting Statement - Gen IC 0935-0179 AHRQ QI Customer Survey 2025.docx Supporting Statement - Gen IC 0935-0179 AHRQ QI Customer Survey 2025	IC Document
OMB Cover Letter 01242025.docx OMB Cover Letter	IC Document
OMB Cover Letter 01242025.docx OMB Cover Letter	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1				Yes	Yes	Fillable Fileable
Form and Instruction	2				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2018 AHRQ QI SURVEY		01/23/2025
Memo - Changes to the 2018 Survey		01/24/2025
Supporting Statement - Gen IC 0935-0179 AHRQ QI Customer Survey 2025		01/24/2025
OMB Cover Letter		01/24/2025

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

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