Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

ICR 202401-0935-006

OMB: 0935-0124

Federal Form Document

Forms and Documents

Document Name	Status
Form 1 Provider Focus Group Form and Instruction	Unchanged
Form 1 Provider and Patient Interview Form and Instruction	Unchanged
Form 1 Patient and Caregiver Usability Interview Form and Instruction	Unchanged
Form 1 Patient and Caregiver Survey Form and Instruction	Unchanged
Form 1 MEPS Alternative Sampling Design Pilot Test Form and Instruction	Unchanged
Form 1B Feasibility Study for a MEPS Monthly Check-In Form and Instruction	Unchanged
Form 1 Pilot Test of the Proposed Workplace Safety Supplemental Item Set For the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey Form and Instruction	Unchanged
Form 1 Field Test of A Survey of End-of-Life Care Form and Instruction	Unchanged
Form 1 Pilot Test of the Revised Data Collection Method for the Medical Expenditure Panel Survey - Insurance Component Form and Instruction	Unchanged
Attachment D - Generic Clearance Submission.docx Supplementary Document	2024-01-25
Attachment B - Data Collections under Generic 0935-0124.docx Supplementary Document	2024-01-25
Attachment A - Healthcare Research and Quality Act of 1999.pdf Supplementary Document	2024-01-25
Supporting Statement Part B - Generic 0935-0124 Questionnaire and Data Collection Testing, Evaluation and Research.docx Supporting Statement B	2024-01-25
Supporting Statement Part A - Generic 0935-0124 Questionnaire and Data Collection Testing Evaluation and Research_012524.docx Supporting Statement A	2024-01-25

IC Document Collections

IC ID	Document Title	Status
263760	Provider Focus Group Form and Instruction	Unchanged
263759	Provider and Patient Interview Form and Instruction	Unchanged
263758	Patient and Caregiver Usability Interview Form and Instruction	Unchanged
263757	Patient and Caregiver Survey Form and Instruction	Unchanged
252822	MEPS Alternative Sampling Design Pilot Test Form and Instruction	Unchanged
251475	Feasibility Study for a MEPS Monthly Check-In Form and Instruction	Unchanged
251418	Pilot Test of the Proposed Workplace Safety Supplemental Item Set For the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey Form and Instruction	Unchanged
249349	Field Test of A Survey of End-of-Life Care Form and Instruction	Unchanged
246524	Pilot Test of the Revised Data Collection Method for the Medical Expenditure Panel Survey - Insurance Component Form and Instruction	Unchanged