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CAHPS Clinician & Group Survey, Adult Primary Care Questionnaire
CAHPS Field Test of Proposed Health Information Technology Questions and Methodology
OMB: 0935-0158
IC ID: 189786
OMB.report
HHS/AHRQ
OMB 0935-0158
ICR 200907-0935-001
IC 189786
( )
Documents and Forms
Document Name
Document Type
Form Form #1
CAHPS Clinician & Group Survey, Adult Primary Care Questionnaire
Form and Instruction
Form #1 4 Point Scale Questionnaire
Attachment B1 Questionnaire with 4pt Scale 6-17-2009.doc
Form and Instruction
Form #2 6 Point Scale Questionnaire
Attachment B2 Questionnaire with 6pt Scale 6-17-2009.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CAHPS Clinician & Group Survey, Adult Primary Care Questionnaire
Agency IC Tracking Number:
Is this a Common Form?
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
Form #1
4 Point Scale Questionnaire
Attachment B1 Questionnaire with 4pt Scale 6-17-2009.doc
Yes
Yes
Fillable Fileable
Form and Instruction
Form #2
6 Point Scale Questionnaire
Attachment B2 Questionnaire with 6pt Scale 6-17-2009.doc
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
7,200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
7,200
0
7,200
0
0
0
Annual IC Time Burden (Hours)
2,400
0
2,400
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.