Federal Register / Vol. 74, No. 139 / Wednesday, July 22, 2009 / Notices 36235 

automated collection techniques or 

other forms of information technology. 

Comments submitted in response to 

this notice will be summarized and 

included in the Agency’s subsequent 

request for OMB approval of the 

proposed information collection. All 

comments will become a matter of 

public record. 

Dated: July 8, 2009. 

Carolyn M. Clancy, 

Director. 

[FR Doc. E9–17203 Filed 7–21–09; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Agency for Healthcare Research 

and Quality, HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

intention of the Agency for Healthcare 

Research and Quality (AHRQ) to request 

that the Office of Management and 

Budget (OMB) approve the proposed 

information collection project: ‘‘Health 

Literacy Item Set Supplemental to 

CAHPS Hospital Survey—Pretest of 

Proposed Questions and Methodology.’’ 

In accordance with the Paperwork 

Reduction Act of 1995, Public Law 104– 

13 (44 U.S.C. 3506(c)(2)(A)), AHRQ 

invites the public to comment on this 

proposed information collection. 

This proposed information collection 

was previously published in the Federal 

Register on May 13th, 2009 and allowed 

60 days for public comment. The 

purpose of this notice is to allow an 

additional 30 days for public comment. 

This notice differs from the 60 day 

notice in the following ways: (1) The 

burden hours are increased from 200 to 

250, and (2) an incentive experiment 

has been added. 

DATES: Comments on this notice must be 

received by August 21, 2009. 

ADDRESSES: Written comments should 

be submitted to: AHRQ’s OMB Desk 

Officer by fax at (202) 395–6974 

(attention: AHRQ’s desk officer) or by email at OIRA_submission@omb.eop.gov 

(attention: AHRQ’s desk officer). 

Copies of the proposed collection 

plans, data collection instruments, and 

specific details on the estimated burden 

can be obtained from the AHRQ Reports 

Clearance Officer. 

FOR FURTHER INFORMATION CONTACT: 

Doris Lefkowitz, AHRQ Reports 

Clearance Officer, (301) 427–1477, or by 

e-mail at doris.lefkowitz@ahrq.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

‘‘Health Literacy Item Set Supplemental 

to CAHPS Hospital Survey—Pretest of 

Proposed Questions and Methodology’’ 

AHRQ proposes to conduct a pretest 

of the Consumer Assessment of 

Healthcare Providers and Systems 

(CAHPS®) Hospital Survey health 

literacy module. The CAHPS program is 

a multi-year initiative of the Agency for 

Healthcare Research and Quality. AHRQ 

first launched the program in October 

1995 in response to concerns about the 

lack of good information about the 

quality of health plans from the 

enrollees’ perspective. Numerous public 

and private organizations collected 

information on enrollee and patient 

satisfaction, but the surveys varied from 

sponsor to sponsor and often changed 

from year to year. The CAHPS® 

program was designed to make it 

possible to compare survey results 

across sponsors and over time, and to 

generate tools and resources that 

sponsors can use to produce 

understandable and usable comparative 

information for consumers. 

Over time, the program has expanded 

beyond its original focus on health 

plans to address a range of health care 

services to meet the various needs of 

health care consumers, purchasers, 

health plans, providers, and 

policymakers. Based on a literature 

review and an assessment of currently 

available questionnaires, AHRQ 

identified the need to develop a health 

literacy module for the CAHPS® 

Hospital Survey. The intent of the 

planned module is to examine patients’ 

perspectives on how well health 

information is communicated to them 

by healthcare professionals in the 

hospital setting. The objective of the 

new module is to provide information to 

health plans, hospitals, clinicians, group 

practices, and other interested parties 

regarding the quality of health 

information delivered to patients. The 

set of questions about health literacy 

will be evaluated as a supplement to the 

CAHPS® Hospital Survey. 

This study will be conducted for 

AHRQ by its contractor, RAND 

Corporation. It is being conducted 

pursuant to AHRQ’s statutory authority 

to conduct research and evaluations on 

health care and systems for the delivery 

of such care, including activities with 

respect to (1) the quality, effectiveness, 

efficiency, appropriateness and value of 

health care services. See 42 U.S.C. 

299a(a)(1). 

This study is a one-time field test to 

be completed in the calendar years 2009 

and 2010. The field test to be conducted 

under this request will be done for the 

following purposes: 

a. Analysis of item wording—Assess 

candidate wordings for items. 

b. Analysis of participation rate— 

Evaluate the overall response rate and 

the proportion of that obtained from 

mail versus telephone modes of data 

collection. 

c. Case mix adjustment analysis— 

Evaluate variables that need to be 

considered for case mix adjustment of 

scores. 

d. Psychometric analysis—Provide 

information for the revision of the 

health literacy item set based on the 

assessment of the reliability and 

validity. 

e. Incentive experiment—Provide 

information on the effectiveness of a 

post-paid, $5 incentive as a mechanism 

to enhance response by randomizing 

half the sample at one site to an 

experiment in which a post-paid 

incentive of $5 is provided for 

completing the survey. 

The end result will be collection of 

the data related to the assessment of 

patients’ perspective on how well health 

information is communicated to them 

by health care professionals in a 

hospital setting. The field testing will 

ensure that future data collections yield 

high quality data and minimize 

respondent burden, increase agency 

efficiency, and improve responsiveness 

to the public. The survey items will be 

added to currently available CAHPS® 

surveys and will enhance the ability of 

hospitals to assess the quality of their 

services. 

Method of Collection 

The potential respondent universe is 

persons who had at least one overnight 

stay at a hospital within the previous 

five months. Excluded from the study 

will be those who were less than 18 

years old at the time of their admission, 

had a psychiatric diagnosis, were 

discharged to a hospice facility or died 

during the hospitalization. Testing sites 

will be selected purposively based on 

several considerations, including ability 

to execute the activities necessary to 

participate in the pilot, number of beds, 

number of discharges for medical, 

surgical, and obstetric patients, average 

length of stay, location (urban versus 

rural), profit status, and academic 

medical center status. 

The draw will be a sample large 

enough to yield approximately 600 

completes. It is assumed that 


jlentini on DSKJ8SOYB1PROD with NOTICES
36236 Federal Register / Vol. 74, No. 139 / Wednesday, July 22, 2009 / Notices 

approximately 1,200 patients will be 

sampled across all field sites with a 

response rate of 50%. This pretest will 

use a mixed mail-telephone mode of 

data collection which will include the 

following steps: 

• Mailing an advanced notification 

letter. 

• Mailing of the questionnaire and 

cover letter. 

• Postcard reminder. 

• A second mailing of the 

questionnaire to non-respondents. 

• Up to 10 telephone calls to every 

mail non-respondent approximately two 

weeks after the final mailing. 

Every effort will be made to maximize 

the response rate, while retaining the 

voluntary nature of the effort. An 

advance notice will be mailed prior to 

mailing the survey and will include a 

letter explaining what the survey is 

about, who is doing it and why, and 

providing contact information for 

questions. The second mailing and 

telephone follow-up are expected to 

result in significant increases in 

response. Every effort to maximize the 

response rate among Spanish-speaking 

respondents will be made. A Spanish 

version of the advance notice, the 

questionnaire, cover letters, and the 

reminder card, as well as a Spanish 

version of the telephone transcript has 

been developed. The cover letters in 

English include a note in Spanish 

instructing respondents to call a toll free 

number if they would like to receive a 

copy of the survey in Spanish. In 

addition, participating field sites will 

ask for information on language 

preference and/or race/ethnicity of 

sample patients so that the mailing of 

the survey can be tailored for Spanishspeakers. 

Finally, phone follow-up to 

respondents who do not complete the 

survey by mail will be conducted by 

bilingual interviewers so that those who 

want to complete the survey by 

telephone in either English or Spanish 

can accommodated. 

Surveys generally do not yield 

complete responses from every 

individual sampled from the 

population. In this analysis, patterns of 

both unit and item nonresponse will be 

examined and modeled, and the 

potential impact of nonresponse bias 

assessed. A common set of 

administrative variables (e.g., age, 

gender, race/ethnicity) will be used to 

predict unit nonresponse. These 

variables and others collected on the 

survey itself will be used as predictors 

of item nonresponse. Case mix 

adjustment and nonresponse weights 

will be used to more accurately reflect 

consumer experiences with health care 

in the field test hospitals. Multivariate 

logistic regression models will be used 

to analyze the factors associated with 

unit nonresponse and item 

nonresponse. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden for the respondents’ 

time to participate in this data 

collection. The CAHPS Hospital Survey 

Health Literacy Module will be 

completed by about 600 persons. The 

estimated response time of 25 minutes 

is based on the written length of the 

survey and AHRQ’s experience with 

previous CAHPS® surveys of 

comparable length that were fielded 

with similar samples. The total burden 

hours are estimated to be 250 hours. 

Exhibit 2 shows the respondents’ cost 

burden associated with their time to 

participate in this data collection. The 

total cost burden of completing pretest 

is estimated to be $4,890. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Mail survey with reminder card, mail and phone follow-up ............................. 600 1 25/60 250 

Total .......................................................................................................... 600 1 na 250 

EXHIBIT 2—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Total burden 

hours 

Average hourly wage rate* Total cost 

burden 

Mail survey with reminder card, mail and phone follow-up ............................. 600 250 $19.56 $4,890 

Total .......................................................................................................... 600 250 na 4,890

*Based upon the average wages, ‘‘National Compensation Survey: Occupational Wages in the United States, May 2007,’’ U.S. Department of 

Labor, Bureau of Labor Statistics. 

Estimated Annual Costs to the Federal 

Government 

The total cost for the contracted 

service is approximately $245,000 and 

the cost for AHRQ staff to oversee the 

project is $50,000, including benefits. 

The project was initiated in October of 

2008 and it is forecasted that it will be 

completed in 18 months. The initial 

developmental work has been 

completed within the first ten months of 

the project and it is forecasted that the 

pretest, analysis and finalization of the 

Health Literacy Item Set supplemental 

to CAHPS Hospital Survey can be 

completed within the next eight 

months. It is estimated that the total cost 

of the project is approximately 

$295,000. The annualized cost of the 

project is approximately $196,669. 

EXHIBIT 3—ESTIMATED COST

Cost component Total cost Annualized 

cost 

Review of literature .................................................................................................................................................. $20,000 $13,334 

Cognitive interviews ................................................................................................................................................. 60,000 40,000 

Field test .................................................................................................................................................................. 90,000 60,000 


jlentini on DSKJ8SOYB1PROD with NOTICES
Federal Register / Vol. 74, No. 139 / Wednesday, July 22, 2009 / Notices 36237 

EXHIBIT 3—ESTIMATED COST—Continued 

Cost component Total cost Annualized 

cost 

Data analyses .......................................................................................................................................................... 40,000 26,667 

Finalize survey ......................................................................................................................................................... 35,000 23,334 

AHRQ project management .................................................................................................................................... 50,000 33,334 

Total .................................................................................................................................................................. 295,000 196,669 

Request for Comments 

In accordance with the above-cited 

Paperwork Reduction Act legislation, 

comments on AFIRQ’s information 

collection are requested with regard to 

any of the following: (a) Whether the 

proposed collection of information is 

necessary for the proper performance of 

AHRQ health care research and health 

care information dissemination 

functions, including whether the 

information will have practical utility; 

(b) the accuracy of AHRQ’s estimate of 

burden (including hours and costs) of 

the proposed collection(s) of 

information; (c) ways to enhance the 

quality, utility, and clarity of the 

information to be collected; and (d) 

ways to minimize the burden of the 

collection of information upon the 

respondents, including the use of 

automated collection techniques or 

other forms of information technology. 

Comments submitted in response to 

this notice will be summarized and 

included in the Agency’s subsequent 

request for OMB approval of the 

proposed information collection. All 

comments will become a matter of 

public record. 

Dated: July 8, 2009. 

Carolyn M. Clancy, 

Director. 

[FR Doc. E9–17201 Filed 7–21–09; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for OMB review; Comment 

Request 

Title: National Survey of Child and 

Adolescent Well-Being Second Cohort 

(NSCAW II). 

OMB No.: 0970–0202. 

Description: The Department of 

Health and Human Services (HHS) 

intends to collect follow-up data on a 

sample of children and families for the 

National Survey of Child and 

Adolescent Well-Being (NSCAW). The 

NSCAW was authorized under section 

427 of the Personal Responsibility and 

Work Opportunities Reconciliation Act 

of 1996. The NSCAW is the only source 

of nationally representative, firsthand 

information about the functioning and 

well-being, service needs, and service 

utilization of children and families who 

come to the attention of the child 

welfare system. Information is collected 

about children’s cognitive, social, 

emotional, behavioral, and adaptive 

functioning, as well as family and 

community factors that are likely to 

influence their functioning. Family 

service needs and service utilization 

also are addressed in the data collection. 

Selection of the current NSCAW 

sample and baseline data collection 

began in 2007 with a final anticipated 

sample size of 5,700 children. The 

proposed data collection will allow for 

follow-up of this sample 18 months 

post-baseline, and will follow the same 

format as that used in the baseline 

round and will employ, with only 

modest revisions, the same instruments 

that were used in the previous round. 

Data from NSCAW are made available to 

the research community through 

licensing arrangements from the 

National Data Archive on Child Abuse 

and Neglect at Cornell University. 

Respondents: Children and their 

associated permanent or foster 

caregivers, caseworkers, and teachers. 

ANNUAL BURDEN ESTIMATES

Instrument Number of 

respondents 

Number of 

responses per 

respondent 

Average burden 

hours per 

response 

Total burden 

hours 

Child Interview ............................................................................................... 1,424 1 1 .33 1,894 

Caregiver Interview ........................................................................................ 1,424 1 1 .9 2,706 

Caseworker Interview .................................................................................... 285 3 1 855 

Teacher Questionnaire .................................................................................. 855 1 .50 428 

Estimated Total Annual Burden 

Hours: 5,882. 

Additional Information: Copies of the 

proposed collection may be obtained by 

writing to the Administration for 

Children and Families, Office of 

Planning, Research and Evaluation, 370 

L’Enfant Promenade, SW., Washington, 

DC 20447, Attn: OPRE Reports 

Clearance Officer. All requests should 

be identified by the title of the 

information collection. E-mail address: 

OPREinfocollection@acf.hhs.gov. 

OMB Comment: OMB is required to 

make a decision concerning the 

collection of information between 30 

and 60 days after publication of this 

document in the Federal Register. 

Therefore, a comment is best assured of 

having its full effect if OMB receives it 

within 30 days of publication. Written 

comments and recommendations for the 

proposed information collection should 

be sent directly to the following: Office 

of Management and Budget, Paperwork 

Reduction Project, Fax: 202–395–6974, 

Attn: Desk Officer for the 

Administration for Children and 

Families. 

Dated: July 16, 2009. 

Seth F. Chamberlain, 

OPRE Reports Clearance Officer. 

[FR Doc. E9–17301 Filed 7–21–09; 8:45 am] 

BILLING CODE 4184–01–M 


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