OMB control number

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

OMB 0935-0179 · HHS/AHRQ.

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 2026-11-30 and is listed under ICR 202501-0935-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 1 ED PQI Feedback SurveyForm and Instruction
Form 1 ED PQI Feedback SurveyForm and Instruction
Form 1 Survey Instrument – QI Software UsersForm
Form 1 QI Program User SurveyForm
Form 2 Web Screener SurveyForm and Instruction
Form 1 Usability ScriptForm and Instruction
Form 1 Voluntary Customer Satisfaction Survey of AHRQ PSNet UsersForm and Instruction
Form 2 Proposed Approach for Task 7Form and Instruction
Form 1 Proposed Approach for Task 3Form and Instruction
Form 1 TA User Feedback for Program and User Support and Quality Measure Tool Development for CAHPS® and SOPSForm and Instruction
Form 1 Appendix A: Interview ProtocolForm and Instruction
Form 1 The AHRQ Safety Program for Improving Surgical Care and Recovery (ISCR) Qualitative EvaluationForm and Instruction
Form 1 Appendix AForm 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 SubscribersForm and Instruction
Form 1 PCLC SurveyForm and Instruction
Form 1 Agency for Healthcare Research and Quality (AHRQ) COVID-19 Primary Care Learning Community Participant SurveyForm and Instruction
Form 4a Appendix D_Post-test Interview Protocol final 6 17 21Form and Instruction
Form 3a Appendix C_Pre-test Interview Protocol_final_ 6 17 21Form and Instruction
Form 1a Appendix A_Respondent Characteristics_final_6 17 21Form and Instruction
Form 4 Appendix D: Post-test Evaluation Interview ProtocolForm and Instruction
Form 3 Appendix C: Pre-Test Interview ProtocolForm and Instruction
Form 2 Appendix B: Safety Attitude SurveyForm and Instruction
Form 1 Appendix A: Individual Respondent Characteristics SurveyForm and Instruction
Form 1 Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation PlanForm and Instruction
Form 1 Appendix AForm and Instruction
Form 1 ECHO National Nursing Home COVID-19 Action Network Customer Satisfaction SurveyForm and Instruction
Form 3 Appendix D: Post-test Evaluation Interview ProtocolForm and Instruction
Form 3 Appendix C: Pre-Test Interview ProtocolForm and Instruction
Form 2 Appendix B: Organizational Readiness for Implementation Change (ORIC)Form and Instruction
Form 1 Appendix A: Organizational Characteristics SurveyForm and Instruction
Form 1 Building Diagnostic Safety Capacity - Diagnostic Safety Measurement Resource Evaluation PlanForm and Instruction
Form 1 AHRQ Data Tools Interview GuideForm and Instruction
Form 1 Information Gathering and Usability Testing for AHRQ Data Tools Platform Development and MaintenanceForm and Instruction
Form 12 Appendix L: Training Observation ToolForm and Instruction
Form 11 Appendix K: Pilot Test Evaluation Protocol for Administrators – No TeamSTEPPS®Form and Instruction
Form 10 Appendix J: Pilot Test Evaluation Protocol for Administrators – TeamSTEPPS®Form and Instruction
Form 9 Appendix I: Pilot Test Evaluation Protocol for Staff – No TeamSTEPPS®Form and Instruction
Form 8 Appendix H: Pilot Test Evaluation Protocol for Staff – TeamSTEPPS®Form and Instruction
Form 7 Appendix G: Pilot Test Interview Protocol for Providers – No TeamSTEPPS®Form and Instruction
Form 6 Appendix F: Pilot Test Interview Protocol for Providers – TeamSTEPPS®Form and Instruction
Form 5 Appendix E: Organizational Readiness for Implementation Change (ORIC)Form and Instruction
Form 4 Appendix D: Individual Respondent Characteristics (Admin)Form and Instruction
Form 3 Appendix C: Individual Respondent Characteristics (Staff)Form and Instruction
Form 2 Appendix B: Individual Respondent Characteristics (Providers)Form
Form 1 Appendix A: Setting Demographics SurveyForm and Instruction
Form 1 Building Diagnostic Safety Capacity – TeamSTEPPS® Course EvaluationForm and Instruction
Form 1 Nominator/Partner SurveyForm and Instruction
Form 1 Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) DivisionForm and Instruction
Form 7 AppendixForm and Instruction
Form 6 Appendix FForm and Instruction
Form 5 Appendix EForm and Instruction
Form 4 Appendix DForm and Instruction
Form 3 Appendix CForm and Instruction
Form 2 Appendix BForm and Instruction
Form 1 Appendix AForm and Instruction
Form 1 Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building ContractForm and Instruction
Form 1 Card Sort B: Online Data Collection for AHRQ.govForm and Instruction
Form 1 Card Sort B: Online Data Collection for AHRQ.govForm and Instruction
Form 1 Card Sort A: Online Data Collection for AHRQ.govForm and Instruction
Form 1 Card Sort A: Online Data Collection for AHRQ.govForm and Instruction
Form 4 Post Website EvaluationForm and Instruction
Form 3 End user Survey to support redesign of the NCEPCR website: Primary Care ResearchersForm and Instruction
Form 2 End user Survey to support redesign of the NCEPCR website: Primary Care clinicians/Quality Improvement LeadersForm and Instruction
Form 1 End user Survey to support redesign of the NCEPCR website: Primary Care clinicians/Quality Improvement LeadersForm and Instruction
Form 1 End user Survey to support redesign of the National Center for Excellence in Primary Care Research websiteForm and Instruction
Form 1 Nominator/Partner SurveyForm and Instruction
Form 1 Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) DivisionForm and Instruction
Form 2 HSPCR Interview Guide: Researchers in HSR and PCRForm and Instruction
Form 1 HSPCR Interview Guide: Other Stakeholders in HSR and PCRForm and Instruction
Form 1 Health Services and Primary Care Research (HSPCR) Study, Stakeholder InterviewsForm and Instruction
Form 1 INTERVIEW DISCUSSION GUIDESForm and Instruction
Form 1 Information Gathering and Usability Testing to Harmonize AHRQ Data ToolsForm and Instruction
Form 1 Web-based SurveyForm and Instruction
Form 1 Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer SurveyForm and Instruction
Form 1 System Usability Scale (SUS)Form and Instruction
Form 1 System Usability Scale (SUS)Form and Instruction
Form 1 Health Information Technology Professional Interview GuideForm and Instruction
Form 1 Health Information Technology Professional Interview GuideForm and Instruction
Form 1 Provider Interview GuideForm and Instruction
Form 1 Provider Interview GuideForm and Instruction
Form 1 Patient Interview GuideForm and Instruction
Form 1 Patient Interview GuideForm and Instruction
Form 1 Readiness for Change AssessmentForm and Instruction
Form 1 Readiness for Change AssessmentForm and Instruction
Form 1 Request for Opioid Project InformationForm and Instruction
Form 1 Request for Opioid Project Information from Patient Safety Organizations (PSOs)Form and Instruction
Form 2 AHRQ QI Survey 2025 - Track ChangesForm and Instruction
Form 1 AHRQ QI Survey 2025 - CleanForm and Instruction
Form 1 Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer SurveyForm and Instruction
Form 2 Questions for Users of CAHPS Technical AssistanceForm and Instruction
Form 1 Questions for Users of SOPS Technical AssistanceForm 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 SaForm and Instruction
Form 5 Category 5Form and Instruction
Form 4 Category 4Form and Instruction
Form 3 Category 3Form and Instruction
Form 2 Category 2Form and Instruction
Form 1 Category 1Form 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 StakeholdersForm and Instruction
Form 1 Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) ProgramForm and Instruction
Form 1 Patient Key InformantsForm and Instruction
Form 1 Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) DivisionForm and Instruction
Form 1 Nominator Customer Satisfaction SurveyForm and Instruction
Form 1 Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) DivisionForm and Instruction
Form 1 Attachment A—AHRQ National Healthcare Quality and Disparities Reports (QDR) and National Quality Strategy (NQS) Customer Satisfaction Interview GuideForm and Instruction
Form 1 Customer Satisfaction Analysis for the AHRQ National Healthcare Quality and Disparities Report and National Quality Strategy Products and WebsitesForm and Instruction
Form 1 Questions for StakeholdersForm and Instruction
Form 1 Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) ProgramForm and Instruction
Form 1 Questions for Patient Key InformantsForm and Instruction
Form 1 Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) DivisionForm and Instruction
Form 1 Nominator Customer Satisfaction SurveyForm and Instruction
Form 1 Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) DivisionForm and Instruction
Form 2 2. Appendix B – Moderator GuideForm and Instruction
Form 2 Focus Groups on TeamSTEPPS® for Long-Term Care CurriculumForm and Instruction
Form 2 MONAHRQ Professional End Users Focus Group protocolForm and Instruction
Form 1 AHRQ.gov Taxonomy Tree TestForm and Instruction
Form 1 AHRQ.gov Taxonomy Tree TestForm and Instruction
Justification for Change Memo.docxJustification for No Material/Nonsubstantive Change
Justification for Change Memo.docx Justification for No Material/Nonsubstantive Change
60 Day FRN.pdfSupplementary Document
60 Day FRN.pdf Supplementary Document
Supporting Statement Part B -- Generic Clearance.docxSupporting Statement B
Supporting Statement Part B -- Generic Clearance.docxSupporting Statement B
SS Part A - 0935-0179 - Generic Clearance of Qualitative Feedback - 10262023.docxSupporting Statement A
SS Part A - 0935-0179 - Generic Clearance of Qualitative Feedback - 10262023.docxSupporting Statement A
Generic Clearance Submission Template.docSupplementary Document
Generic Clearance Submission Template.doc Supplementary Document
Attachment A -- Healthcare Research and Quality Act of 1999.pdfSupplementary Document
Attachment A -- Healthcare Research and Quality Act of 1999.pdf Supplementary Document
ED PQI Feedback Survey Form and Instruction
ED PQI Feedback Survey Form and Instruction
QI Program User Survey Form
QI Program User Survey Form
Voluntary Customer Satisfaction Survey of AHRQ PSNet Users Form and Instruction
Voluntary Customer Satisfaction Survey of AHRQ PSNet Users Form and Instruction
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
TA User Feedback for Program and User Support and Quality Measure Tool Development for CAHPS® and SOPS 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
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 Other-Instrument
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
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
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
Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan Form and Instruction
Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan Form and Instruction
Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan Form and Instruction
Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan Form and Instruction
Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan Form and Instruction
Building Diagnostic Safety Capacity - Diagnostic Calibration Resource Evaluation Plan 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
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
Building Diagnostic Safety Capacity - Diagnostic Safety Measurement Resource Evaluation Plan Form and Instruction
Building Diagnostic Safety Capacity - Diagnostic Safety Measurement Resource Evaluation Plan Form and Instruction
Building Diagnostic Safety Capacity - Diagnostic Safety Measurement Resource Evaluation Plan 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
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
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form
Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation 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
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
Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Form and Instruction
Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Form and Instruction
Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Form and Instruction
Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Form and Instruction
Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract Form and Instruction
Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract 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 B: Online Data Collection for AHRQ.gov Form and Instruction
Card Sort A: 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
End user Survey to support redesign of the National Center for Excellence in Primary Care Research website Form and Instruction
End user Survey to support redesign of the National Center for Excellence in Primary Care Research website Form and Instruction
End user Survey to support redesign of the National Center for Excellence in Primary Care Research website 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
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
Health Services and Primary Care Research (HSPCR) Study, Stakeholder Interviews 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
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
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey Form and Instruction
System Usability Scale (SUS) Form and Instruction
System Usability Scale (SUS) Form and Instruction
Health Information Technology Professional Interview Guide Form and Instruction
Health Information Technology Professional Interview Guide Form and Instruction
Provider Interview Guide Form and Instruction
Provider Interview Guide Form and Instruction
Patient Interview Guide Form and Instruction
Patient Interview Guide Form and Instruction
Readiness for Change Assessment Form and Instruction
Readiness for Change Assessment Form and Instruction
Request for Opioid Project Information from Patient Safety Organizations (PSOs) 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
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey 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
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
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 Interviews for Task 1 of AHRQ's SPPC-II Contract (RFTOP #17-233-SOL-00520) Form and Instruction
Stakeholder Interviews for Task 1 of AHRQ's SPPC-II Contract (RFTOP #17-233-SOL-00520) Form and Instruction
Stakeholder Interviews for Task 1 of AHRQ's SPPC-II Contract (RFTOP #17-233-SOL-00520) Form and Instruction
Stakeholder Interviews for Task 1 of AHRQ's SPPC-II Contract (RFTOP #17-233-SOL-00520) 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
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
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
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
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
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
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
Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division Form and Instruction
Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum Other-screener
Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum Form and Instruction
Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum Form and Instruction
MONAHRQ Program Evaluation End User Focus Groups Protocol Form and Instruction
MONAHRQ Program Evaluation End User Focus Groups Protocol Instruction
AHRQ.gov Taxonomy Tree Test Form and Instruction
AHRQ.gov Taxonomy Tree Test Form and Instruction

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OMB Details

AHRQ.gov Taxonomy Tree Test

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form 1AHRQ.gov Taxonomy Tree TestFillable FileableForm and instruction

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