Information Collection

Voluntary Customer Satisfaction Survey of AHRQ PSNet Users

IC 252763 under ICR 202501-0935-001 · OMB 0935-0179.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Voluntary Customer Satisfaction Survey of AHRQ PSNet Users	Form and Instruction
Form 1 Usability Script Voluntary Customer Satisfaction Survey of AHRQ PSNet Users	Form and Instruction
Form 2 Web Screener Survey Voluntary Customer Satisfaction Survey of AHRQ PSNet Users	Form and Instruction
1 Usability Script Usability Scriptv2.docx	Form and Instruction
1 Usability Script Usability Scriptv2.docx	Form and Instruction
2 Web Screener Survey Web Screener Questionsv1.docx	Form and Instruction
2 Web Screener Survey Web Screener Questionsv1.docx	Form and Instruction
OMB Cover Letter.docx Cover Letter	IC Document
OMB Cover Letter.docx Cover Letter	IC Document
Submission Form-2022-PSNet_V2.docx Supporting Statement	IC Document
Submission Form-2022-PSNet_V2.docx Supporting Statement	IC Document
Usability Consent Form.docx Consent form	IC Document
Usability Consent Form.docx Consent form	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Unchanged

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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