OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Patient-Centered Medical Home (PCMH) Items Demonstration Study.

OMB 0935-0236 · HHS/AHRQ.

OMB 0935-0236

Latest Forms, Documents, and Supporting Material

Document Name
Form 5 PCMH-A Assessment Tool Form and Instruction
Form 3 Physician/PCMH Leader Interview Form and Instruction
Form 1 Office Manager Inerview Form
PCMH Items Demonstration_OMB Statement A_05152017_FINAL_TC.doc Supporting Statement A
PCMH Items Demonstration_OMB Statement B_05152017_FINAL.doc Supporting Statement B
60 Day FRN.pdf Supplementary Document
Attachment F-INFO SHEET_15May2017_FINAL.docx Supplementary Document
Attachment E-AHRQ Endorsement-signed_FINAL.pdf Supplementary Document
Attachment D-PhysicianPCMHLeaderCoverLetter_15May2017_FINAL.docx Supplementary Document
Attachment C-SCRIPT-FINAL.doc Supplementary Document
PCMH-A Assessment Tool Form and Instruction
Physician/PCMH Leader Interview Form and Instruction
Office Manager Inerview Form

All Historical Document Collections

201611-0935-001

Approved with change

New collection (Request for a new OMB Control Number)

2017-01-26