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

OMB 0935-0179

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.

The latest form for Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery expires 2023-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1 QI Program User Survey Form
Form 1 Voluntary Customer Satisfaction Survey of AHRQ PSNet Users Form and Instruction
Form 1 TA User Feedback for Program and User Support and Quality Measure Tool Development for CAHPS® and SOPS Form and Instruction
Form 1 The AHRQ Safety Program for Improving Surgical Care and Recovery (ISCR) Qualitative Evaluation Form and Instruction
Form 1 Administration of "Use of Agency for Healthcare Research and Quality (AHRQ) Tools to Measure Aspects of Patient Safety" Questionnaire to AHRQ SOPS® Listserv Subscribers Form and Instruction
Form 1 Agency for Healthcare Research and Quality (AHRQ) COVID-19 Primary Care Learning Community Participant Survey Form and Instruction
Form 1 Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan Form and Instruction
Form 1 ECHO National Nursing Home COVID-19 Action Network Customer Satisfaction Survey Form and Instruction
Form 1 Building Diagnostic Safety Capacity - Diagnostic Safety Measurement Resource Evaluation Plan Form and Instruction
Form 1 Information Gathering and Usability Testing for AHRQ Data Tools Platform Development and Maintenance Form and Instruction
Form 1 Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Form 1 Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Form 1 Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Form and Instruction
Form 1 Card Sort B: Online Data Collection for AHRQ.gov Form and Instruction
Form 1 Card Sort A: Online Data Collection for AHRQ.gov Form and Instruction
Form 1 End user Survey to support redesign of the National Center for Excellence in Primary Care Research website Form and Instruction
Form 1 Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Form 1 Health Services and Primary Care Research (HSPCR) Study, Stakeholder Interviews Form and Instruction
Form 1 Information Gathering and Usability Testing to Harmonize AHRQ Data Tools Form and Instruction
Form 1 Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Form and Instruction
Form 1 System Usability Scale (SUS) Form and Instruction
Form 1 Health Information Technology Professional Interview Guide Form and Instruction
Form 1 Provider Interview Guide Form and Instruction
Form 1 Patient Interview Guide Form and Instruction
Form 1 Readiness for Change Assessment Form and Instruction
Form 1 Request for Opioid Project Information from Patient Safety Organizations (PSOs) Form and Instruction
Form 1 Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Form and Instruction
Form 1 Technical Assistance (TA) User Feedback for Program and User Support and Quality Measure Tool Development for Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Surveys on Patient Sa Form and Instruction
Form 1 Stakeholder Interviews for Task 1 of AHRQ's SPPC-II Contract (RFTOP #17-233-SOL-00520) Form and Instruction
Form 1 Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program Form and Instruction
Form 1 Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Form 1 Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Form 1 Customer Satisfaction Analysis for the AHRQ National Healthcare Quality and Disparities Report and National Quality Strategy Products and Websites Form and Instruction
Form 1 Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program Form and Instruction
Form 1 Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Form 1 Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Form 2 Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum Form and Instruction
Form 1 AHRQ.gov Taxonomy Tree Test Form and Instruction
Attachment D – Data collections currently approved under 0935-0179.docx Supplementary Document
60 Day FRN.pdf Supplementary Document
Supporting Statement Part B -- Generic Clearance.docx Supporting Statement B
SS Part A - 0935-0179 - Generic Clearance of Qualitative Feedback - 10042023.docx Supporting Statement A
Generic Clearance Submission Template.doc Supplementary Document
Attachment A -- Healthcare Research and Quality Act of 1999.pdf Supplementary Document
QI Program User Survey Form
Voluntary Customer Satisfaction Survey of AHRQ PSNet Users Form and Instruction
TA User Feedback for Program and User Support and Quality Measure Tool Development for CAHPS® and SOPS Form and Instruction
The AHRQ Safety Program for Improving Surgical Care and Recovery (ISCR) Qualitative Evaluation Form and Instruction
Administration of "Use of Agency for Healthcare Research and Quality (AHRQ) Tools to Measure Aspects of Patient Safety" Questionnaire to AHRQ SOPS® Listserv Subscribers Form and Instruction
Agency for Healthcare Research and Quality (AHRQ) COVID-19 Primary Care Learning Community Participant Survey Form and Instruction
Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan Form and Instruction
ECHO National Nursing Home COVID-19 Action Network Customer Satisfaction Survey Form and Instruction
Building Diagnostic Safety Capacity - Diagnostic Safety Measurement Resource Evaluation Plan Form and Instruction
Information Gathering and Usability Testing for AHRQ Data Tools Platform Development and Maintenance Form and Instruction
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Form and Instruction
Card Sort B: Online Data Collection for AHRQ.gov Form and Instruction
Card Sort A: Online Data Collection for AHRQ.gov Form and Instruction
End user Survey to support redesign of the National Center for Excellence in Primary Care Research website Form and Instruction
Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Health Services and Primary Care Research (HSPCR) Study, Stakeholder Interviews Form and Instruction
Information Gathering and Usability Testing to Harmonize AHRQ Data Tools Form and Instruction
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Form and Instruction
System Usability Scale (SUS) Form and Instruction
Health Information Technology Professional Interview Guide Form and Instruction
Provider Interview Guide Form and Instruction
Patient Interview Guide Form and Instruction
Readiness for Change Assessment Form and Instruction
Request for Opioid Project Information from Patient Safety Organizations (PSOs) Form and Instruction
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Form and Instruction
Technical Assistance (TA) User Feedback for Program and User Support and Quality Measure Tool Development for Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Surveys on Patient Sa Form and Instruction
Stakeholder Interviews for Task 1 of AHRQ's SPPC-II Contract (RFTOP #17-233-SOL-00520) Form and Instruction
Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program Form and Instruction
Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Customer Satisfaction Analysis for the AHRQ National Healthcare Quality and Disparities Report and National Quality Strategy Products and Websites Form and Instruction
Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program Form and Instruction
Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum Form and Instruction
MONAHRQ Program Evaluation End User Focus Groups Protocol Instruction
AHRQ.gov Taxonomy Tree Test Form and Instruction

All Historical Document Collections

202310-0935-001 Approved with change	Extension without change of a currently approved collection	2023-10-05
202009-0935-002 Approved without change	Extension without change of a currently approved collection	2020-09-21
201709-0935-001 Approved without change	Extension without change of a currently approved collection	2017-09-26
201409-0935-009 Approved with change	Revision of a currently approved collection	2014-09-24
201104-0935-006 Approved without change	New collection (Request for a new OMB Control Number)	2011-04-28

OMB Details

AHRQ.gov Taxonomy Tree Test

Federal Enterprise Architecture: Health - Health Care Services

Form 1

AHRQ.gov Taxonomy Tree Test

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.