Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey

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

OMB: 0935-0179

IC ID: 231422

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)

Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Customer Survey
 
Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 AHRQ QI Survey 2025 - Clean AHRQ QI Survey 2025 - CLEAN.docx Yes Yes Fillable Fileable
Form and Instruction 2 AHRQ QI Survey 2025 - Track Changes AHRQ QI Survey 2025 - Track Changes.docx Yes Yes Fillable Fileable

Health Health Care Services

 

300 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 300 0 0 0 0 300
Annual IC Time Burden (Hours) 50 0 0 0 0 50
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
2018 AHRQ QI SURVEY 2018 AHRQ QI Survey - Screen shots - Final.pdf 01/23/2025
Memo - Changes to the 2018 Survey Memo - Changes to the 2018 Survey 01152025.docx 01/24/2025
Supporting Statement - Gen IC 0935-0179 AHRQ QI Customer Survey 2025 Supporting Statement - Gen IC 0935-0179 AHRQ QI Customer Survey 2025.docx 01/24/2025
OMB Cover Letter OMB Cover Letter 01242025.docx 01/24/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
© 2025 OMB.report | Privacy Policy