Provider Focus Group

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

Documents and Forms

Document Name Document Type
Form 1 Provider Focus Group Form and Instruction
1 Provider Focus Group Provider Focus Group.docx Form and Instruction
1 Provider Focus Group Provider Focus Group.docx Form and Instruction
fast-track-PRA-submission-short-form-3 Provider Focus Group.docx fast track PRA submission short form Provider Focus Group IC Document
fast-track-PRA-submission-short-form-3 Provider Focus Group.docx fast track PRA submission short form Provider Focus Group IC Document
eCarePlan Information Sheet - FOCUS GROUPS.pdf eCarePlan Information Sheet - FOCUS GROUPS IC Document
eCarePlan Information Sheet - FOCUS GROUPS.pdf eCarePlan Information Sheet - FOCUS GROUPS IC Document

Information Collection (IC) Details

IC Title:	Provider Focus Group	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Provider Focus Group	Provider Focus Group.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
fast track PRA submission short form Provider Focus Group	fast-track-PRA-submission-short-form-3 Provider Focus Group.docx	12/01/2023
eCarePlan Information Sheet - FOCUS GROUPS	eCarePlan Information Sheet - FOCUS GROUPS.pdf	12/01/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.