OMB Control No: 0935-0179
ICR Reference No:
202009-0935-002
Status: Active
Previous ICR Reference No: 201709-0935-001
Agency/Subagency: HHS/AHRQ
Agency Tracking No:
Title: Generic Clearance for the
Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved
without change
Conclusion Date: 11/02/2020
Retrieve
Notice of Action (NOA)
Date Received in OIRA:
09/21/2020
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2023
36 Months From Approved
11/30/2020
Responses
10,900
0
10,900
Time Burden (Hours)
3,383
0
3,383
Cost Burden (Dollars)
0
0
0
Abstract: 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.
Authorizing Statute(s): US Code:
42
USC 299 Name of Law: Healthcare Research and Quality Act of
1999
Citations for New Statutory
Requirements: None
Associated Rulemaking
Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices &
Comments
60-day Notice:
Federal Register Citation:
Citation Date:
85 FR
35654
06/11/2020
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR
58061
09/17/2020
Did the Agency receive public comments on
this ICR? No
Number of Information Collection (IC) in this
ICR: 30
IC Title
Form No.
Form Name
Readiness for Change
Assessment
1
Readiness for
Change Assessment
Health Information
Technology Professional Interview Guide
1
Health Information
Technology Professional Interview Guide
Partner/Nominator
Customer Satisfaction Survey for the Evidence Based Practice Center
(EPC) Division
1
Nominator/Partner
Survey
Stakeholder Interviews
for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building
Contract
1, 2, 3, 4, 5, 6, 7
Appendix A ,
Appendix B
, Appendix
C , Appendix D ,
Appendix E ,
Appendix F
, Appendix
Customer Satisfaction
Analysis for the AHRQ National Healthcare Quality and Disparities
Report and National Quality Strategy Products and Websites
1
Attachment A—AHRQ
National Healthcare Quality and Disparities Reports (QDR) and
National Quality Strategy (NQS) Customer Satisfaction Interview
Guide
Stakeholder Interviews
for Task 1 of AHRQ's SPPC-II Contract (RFTOP
#17-233-SOL-00520)
2, 5, 1, 3, 4
Category 1 ,
Category 2
, Category
3 , Category 4 ,
Category 5
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
2, 1
Questions for
Users of SOPS Technical Assistance , Questions for Users of CAHPS
Technical Assistance
System Usability Scale
(SUS)
1
System Usability
Scale (SUS)
Agency for Healthcare
Research and Quality (AHRQ) Quality Indicators (QI) Customer
Survey
1
Web-based
Survey
MONAHRQ Program
Evaluation End User Focus Groups Protocol
2
MONAHRQ Professional End Users
Focus Group protocol
Building Diagnostic
Safety Capacity – TeamSTEPPS® Course Evaluation
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
Appendix D:
Individual Respondent Characteristics (Admin) , Appendix E: Organizational
Readiness for Implementation Change (ORIC) , Appendix F: Pilot Test
Interview Protocol for Providers – TeamSTEPPS® ,
Appendix G: Pilot Test
Interview Protocol for Providers – No TeamSTEPPS® ,
Appendix H: Pilot Test
Evaluation Protocol for Staff – TeamSTEPPS® , Appendix I: Pilot Test
Evaluation Protocol for Staff – No TeamSTEPPS® ,
Appendix J: Pilot Test
Evaluation Protocol for Administrators – TeamSTEPPS® ,
Appendix K: Pilot Test
Evaluation Protocol for Administrators – No TeamSTEPPS® ,
Appendix L:
Training Observation Tool , Appendix B: Individual
Respondent Characteristics (Providers) , Appendix C: Individual
Respondent Characteristics (Staff) , Appendix A: Setting
Demographics Survey
Provider Interview
Guide
1
Provider Interview
Guide
Information Gathering
and Usability Testing to Harmonize AHRQ Data Tools
1
INTERVIEW
DISCUSSION GUIDES
Partner/Nominator
Customer Satisfaction Survey for the Evidence Based Practice Center
(EPC) Division
1
Nominator/Partner
Survey
Card Sort A: Online
Data Collection for AHRQ.gov
1
Card Sort A:
Online Data Collection for AHRQ.gov
Patient Key Informant
Customer Satisfaction Survey for the Evidence Based Practice Center
(EPC) Division
1
Questions for
Patient Key Informants
Patient Key Informant
Customer Satisfaction Survey for the Evidence Based Practice Center
(EPC) Division
1
Patient Key
Informants
Stakeholder Customer
Satisfaction Survey for the Evidence Based Practice Center (EPC)
Program
1
Questions for
Stakeholders
Nominator Customer
Satisfaction Survey for the Evidence Based Practice Center (EPC)
Division
1
Nominator Customer
Satisfaction Survey
Focus Groups on
TeamSTEPPS® for Long-Term Care Curriculum
2
2. Appendix B –
Moderator Guide
Card Sort B: Online
Data Collection for AHRQ.gov
1
Card Sort B:
Online Data Collection for AHRQ.gov
Information Gathering
and Usability Testing for AHRQ Data Tools Platform Development and
Maintenance
1
AHRQ Data Tools
Interview Guide
Agency for Healthcare
Research and Quality (AHRQ) Quality Indicators (QI) Customer
Survey
1
2018 AHRQ QI
SURVEY
Health Services and
Primary Care Research (HSPCR) Study, Stakeholder
Interviews
2, 1
HSPCR Interview
Guide: Other Stakeholders in HSR and PCR , HSPCR Interview Guide:
Researchers in HSR and PCR
End user Survey to
support redesign of the National Center for Excellence in Primary
Care Research website
1, 2, 3, 4
End user Survey to
support redesign of the NCEPCR website: Primary Care
clinicians/Quality Improvement Leaders , End user Survey to support
redesign of the NCEPCR website: Primary Care clinicians/Quality
Improvement Leaders , End user Survey to support
redesign of the NCEPCR website: Primary Care Researchers ,
Post Website
Evaluation
AHRQ.gov Taxonomy Tree
Test
1
AHRQ.gov Taxonomy
Tree Test
Patient Interview
Guide
1
Patient Interview
Guide
Stakeholder Customer
Satisfaction Survey for the Evidence Based Practice Center (EPC)
Program
1
Stakeholders
Nominator Customer
Satisfaction Survey for the Evidence Based Practice Center (EPC)
Division
1
Nominator Customer
Satisfaction Survey
Request for Opioid
Project Information from Patient Safety Organizations
(PSOs)
1
Request for Opioid
Project Information
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in
Estimate
Change Due to Potential Violation of
the PRA
Annual Number of Responses
10,900
10,900
0
0
0
0
Annual Time Burden (Hours)
3,383
3,383
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency
Discretion: No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency
Discretion: No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government: $848,556
Does this IC contain surveys, censuses, or employ
statistical methods? Yes Part B of Supporting Statement
Does this ICR request any personally identifiable
information (see OMB Circular No. A-130 for an
explanation of this term)? Please consult with your agency's
privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act
Statement (see 5
U.S.C. §552a(e)(3) )? Please consult with your agency's privacy
program when making this determination.
No
Is this ICR related to the Affordable Care Act [Pub. L.
111-148 & 111-152]? No
Is this ICR related to the Dodd-Frank Wall Street Reform
and Consumer Protection Act, [Pub. L. 111-203]? No
Is this ICR related to the American Recovery and
Reinvestment Act of 2009 (ARRA)? No
Is this ICR related to the Pandemic Response?
No
Agency Contact: Erwin Brown 301 427-1652
erwin.brown@ahrq.hhs.gov