Cover Letter

Cover Page Patient Interview Guide.doc

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

Cover Letter

OMB: 0935-0179

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SUBMISSION OF INFORMATION COLLECTION UNDER THE

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


DATE OF REQUEST: October 18, 2018


SUB AGENCY (I/C): HHS/AHRQ


TITLE: Patient Interview Guide


GENERIC CLEARANCE UNDER OMB#: 0935-0179 EXP. DATE: 11/30/2020


ABSTRACT:

Providers noted that data from a PRO app would be most useful when the PRO data are likely to have clinical significance and can guide treatment of the patient. As interviews will be conducted following app usage, only patients who have completed the app will be eligible to participate in patient interviews.












TOTAL ANNUAL BURDEN APPROVED: 3,383 Hours Per year

BURDEN USED TO DATE: 404 hours.

BURDEN THIS REQUEST: 9 hours.


FEDERAL COST: The estimated annual cost to the Federal government is $219.06_.


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?

­____ WEB SITE

____ TELEPHONE INTERVIEW

_____ MAIL RESPONSE

_____ IN PERSON INTERVIEW

__x___ OTHER: Interview_

CONTACT INFORMATION:

NAME: _Erwin Brown______________________________

TELEPHONE NUMBER: 301.427.1652________________

EMAIL ADDRESS: _ebrown@ahrq.gov________________

File Typeapplication/msword
File TitleGeneric Clearance Form - 04/28/2008
SubjectGeneric Clearance Form - 04/28/2008
AuthorOD/USER
Last Modified BySYSTEM
File Modified2018-10-29
File Created2018-10-29

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