Cover Letter

SUBMISSION OF INFORMATION COLLECTION UNDER THE

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

DATE OF REQUEST: August 30, 2016

SUB AGENCY (I/C): HHS/AHRQ

TITLE: Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division

GENERIC CLEARANCE UNDER OMB#: 0925-0179 EXP. DATE: 11/30/2017

ABSTRACT:

The mission of the EPC program is to create reports that improve healthcare by supporting evidence-based decision making by patients, providers, and policymakers. To ensure that our reports answer the questions that are important to patient, we invite 1-2 patients or patient representatives as Key Informants to participate in designing the research questions that guide the report. In order to be certain our process effectively engages these patient Key Informants and to make sure that the final report answers their questions, we would like to ask them a few questions via an online tool about their experience and about the final report, once the project is completed and the final report has been posted. This information will be used to improve how we work with patients going forward and to improve the usefulness of our reports for patients.

Organizations that download MONAHRQ and generate reports to help improve health care are referred to as “Host Users.” The Future of MONAHRQ Survey 2014 will be accessible to current and prospective Host Users. Examples of Host Users include: state agencies, public health departments, hospital associations, hospital systems, and individual hospitals, multi-stakeholder alliances and coalitions, Quality Improvement Organizations (QIOs), and health plans.

TOTAL ANNUAL BURDEN APPROVED: 3,383 Hours Per year

BURDEN USED TO DATE: 404 hours.

BURDEN THIS REQUEST: 10 hours.

FEDERAL COST: The estimated annual cost to the Federal government is $600_____.

IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?

______YES ______ NO _____x_ N/A

OBLIGATION TO RESPOND:

___x___ VOLUNTARY

______ REQUIRED TO OBTAIN OR RETAIN BENEFITS

______ MANDATORY

HOW WILL THIS SURVEY BE OFFERED?

___x_ WEB SITE

___ _ TELEPHONE INTERVIEW

_____ MAIL RESPONSE

_____ IN PERSON INTERVIEW

_____ OTHER: ___________________________________

CONTACT INFORMATION:

NAME: _Erwin Brown______________________________

TELEPHONE NUMBER: 301.427.1652________________

EMAIL ADDRESS: _ebrown@ahrq.gov________________