Patient and Caregiver Usability Interview

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

OMB: 0935-0124

IC ID: 263758

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Patient and Caregiver Usability Interview
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Patient and Caregiver Usability Interview Patient and Caregiver Usability Interview.docx Yes Yes Fillable Fileable

Health Health Care Services

 

10 0
   
Individuals or Households
 
   100 %

  Requested 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 10 0 0 0 0 10
Annual IC Time Burden (Hours) 10 0 0 0 0 10
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
fast track PRA submission short form Patient and Caregiver Usability Interview fast-track-PRA-submission-short-form-3 Patient and Caregiver Usability Interview.docx 11/30/2023
eCarePlan Consent Information Sheet - Interview eCarePlan Consent Information Sheet - INTERVIEW.docx 11/30/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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