Information Collection

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

IC 283248 under ICR 202610-0935-001 · OMB 0935-0179.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
AHRQ Quality Indicators (QI) Subtask C.2.9.4 – Draft Survey Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Comprehensive Customer Survey	Form and Instruction
AHRQ Quality Indicators (QI) Subtask C.2.9.4 – Draft Sur AHRQ_QI_2026_Survey_comp -Final_10 26 26 v2.docx	Form and Instruction
Generic 0935-0179 Short-Form Template QI Comprehensive final.docx Generic Short Form QI Comprehensive	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

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	N/A				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Short Form QI Comprehensive		10/23/2026

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

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