OMB control number

Studying the Implementation of a Chronic Care Toolkit and Practice Coaching In Practices Serving Vulnerable Populations

OMB 0935-0166 · HHS/AHRQ.

OMB 0935-0166

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form Form #10 Consumer Assessment of Healthcare Providers and Systems- Primary Care Adult (CAHPS)	Form and Instruction
Form Form #9 Patient Assessment of Chronic Illness Care (PACIC)	Form and Instruction
Form Form #8 Primary Care Staff Satisfaction Survey (PCSSS)	Form and Instruction
Form Form #7 Change Process Capability Questionnaire (CPCQ)	Form and Instruction
Form Form #6 Assessment of Chronic Illness Care (ACIC)	Form and Instruction
Form Form #5 Physician Practice Connections-Readiness Survey (PPC-RS)	Form and Instruction
Form Form #4 Primary Care Practice Profile (PCPP)	Form and Instruction
Form Form #3 Key informant interviews with staff	Form and Instruction
Form Form #2 Key informant interviews with providers	Form and Instruction
Form Form #1 Key informant interviews with practice coaches	Form and Instruction
OMB response Chronic Care Toolkit August 26th 2010.doc	Supplementary Document
omb crosswalk Aug 26 2010.doc	Supplementary Document
Supporting Statement Part B -- Implementing Practice Coaching and the Chronic Care Model 1-8-2010.doc	Supporting Statement B
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document
Attachment L - Chart Audit Abstraction Form.doc	Supplementary Document
Attachment M -- Federal Register Notice.pdf	Supplementary Document
Supporting Statement Part A -- Implementing Practice Coaching and the Chronic Care Model 1-8-2010.doc	Supporting Statement A
Consumer Assessment of Healthcare Providers and Systems- Primary Care Adult (CAHPS)	Form and Instruction
Patient Assessment of Chronic Illness Care (PACIC)	Form and Instruction
Primary Care Staff Satisfaction Survey (PCSSS)	Form and Instruction
Change Process Capability Questionnaire (CPCQ)	Form and Instruction
Assessment of Chronic Illness Care (ACIC)	Form and Instruction
Physician Practice Connections-Readiness Survey (PPC-RS)	Form and Instruction
Primary Care Practice Profile (PCPP)	Form and Instruction
Key informant interviews with staff	Form and Instruction
Key informant interviews with providers	Form and Instruction
Key informant interviews with practice coaches	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201004-0935-002	New collection (Request for a new OMB Control Number)	2010-04-21		Approved with change