Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
AHRQ Quality Indicators (QI) Subtask C.2.9.4 – Draft Survey	Form and Instruction	New	Available
Maternal Health Indicators (MHI) Module Specific Feedback	Form and Instruction	New	Available
SOPS TA User Feedback	Form and Instruction	New	Available
Questions for Users of CAHPS Technical Assistance	Form and Instruction	New	Available
Nominator/Partner Survey	Form and Instruction	New	Available
SS Part A - 0935-0179 - Generic Clearance of Qualitative Feedback - final Oct 2026v3.docx	Supporting Statement A	Uploaded 2026-10-26	Available
revised data collections 0935-0179 October, 2026v2.docx	Supplementary Document	Uploaded 2026-10-26	Available
60 day FRN notice and correction about due date.pdf	Supplementary Document	Uploaded 2026-10-23	Available
Generic 0935-Short-Form Template MS revised to include cost estimatev2-OMB.docx	Supplementary Document	Uploaded 2026-10-23	Available
Supporting Statement Part B -- Generic Clearance.docx	Supporting Statement B	Uploaded 2023-10-04	Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document	Uploaded 2011-04-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
283248	Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Comprehensive Customer Survey	Form and Instruction	New	AHRQ Quality Indicators (QI) Subtask C.2.9.4 – Draft Survey
283247	Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Module-specific User Survey	Form and Instruction	New	Maternal Health Indicators (MHI) Module Specific Feedback
283245	Questions for Users of CAHPS/SOPS Technical Assistance	Form and Instruction	New	SOPS TA User Feedback
283245	Questions for Users of CAHPS/SOPS Technical Assistance	Form and Instruction	New	Questions for Users of CAHPS Technical Assistance
283238	Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	Form and Instruction	New	Nominator/Partner Survey

ICR Details

OMB Control No: 0935-0179	ICR Reference No: 202610-0935-001
Status: Received in OIRA	Previous ICR Reference No: 202501-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/27/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2026
Responses	10,900	10,900
Time Burden (Hours)	3,383	3,383
Cost Burden (Dollars)	0	0

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Abstract: This is a request to extend approval of an existing overarching generic clearance and a subset of GenICs that have been approved over the past three years. There are no changes proposed to the terms of the umbrella generic. Burden estimates are consistent with previous estimates for new collections over the next three years but also include burden for ongoing data collections. This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 53620	08/19/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 63278	10/05/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Comprehensive Customer Survey	N/A	AHRQ Quality Indicators (QI) Subtask C.2.9.4 – Draft Survey
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Module-specific User Survey	N/A	Maternal Health Indicators (MHI) Module Specific Feedback
Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	N/A	Nominator/Partner Survey
Questions for Users of CAHPS/SOPS Technical Assistance	N/A, N/A	Questions for Users of CAHPS Technical Assistance ,   SOPS TA User Feedback

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10,900	10,900	0	0	0	0
Annual Time Burden (Hours)	3,383	3,383	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,802,195

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/27/2026

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