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

Latest forms, documents, and information collections
DocumentType
Form 5 PCMH-A Assessment ToolForm and Instruction
Form 3 Physician/PCMH Leader InterviewForm and Instruction
Form 1 Office Manager InerviewForm
PCMH Items Demonstration_OMB Statement A_05152017_FINAL_TC.docSupporting Statement A
PCMH Items Demonstration_OMB Statement B_05152017_FINAL.docSupporting 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All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201611-0935-001 New collection (Request for a new OMB Control Number) 2017-01-26 Approved with change