2024-15250. Agency Information Collection Activities: Proposed Collection; Comment Request

Exhibit 1—Estimated Annualized Burden Hours

Form name	Number of respondents *	Number of responses per respondent	Hours per response	Total burden hours
1. Structural Assessment	188	2	12/60	75
2. MOSOPS (brick-and-mortar only)	438	2	30/60	438
3. Participant Experience Survey	188	1	20/60	63
4. Semi-structured interviews	18	1	1	18
5. Antibiotic Prescription Data Template	225	18	1	4,050
Total	1,057	na	na	4,644
* Annualized number of respondents is based on maximum practices recruited, assuming 50% of the practices are telemedicine-only and 50% are brick-and-mortar, and 75% response rate for forms 1 and 3, 50% response rate for form 2, and 90% response rate for forms 4 and 5.

Exhibit 2 shows the estimated annualized cost burden based on the respondents' time to complete the data collection forms. The total cost burden is estimated to be $366,163.

Exhibit 2—Estimated Annualized Cost Burden

Form name	Total burden hours	Average hourly wage rate **	Total burden cost
1. Structural Assessment	75	a  $119.54	$8,966
2. AHRQ Medical Office Survey on Patient Safety Culture MOSOPS (brick-and-mortar only)
a. Physicians	219	a  119.54	26,179
b. Other Health Practitioners	219	b  34.04	7,455
3. Participant Experience Survey	63	a  119.54	7,115
4. Semi-structured qualitative interviews	18	a  119.54	2,152
5. Antibiotic Prescription Data Template	4,050	c  76.79	311,000
Total	4,644		366,163
** Annualized number of respondents is based on maximum practices recruited, assuming 50% of the practices are telemedicine-only and 50% are brick-and-mortar, and 75% response rate for forms 1 and 3, 50% response rate for form 2, and 90% response rate for forms 4 and 5.
** National Compensation Survey: Occupational wages in the United States May 2023 “U.S. Department of Labor, Bureau of Labor Statistics:” https://www.bls.gov/​oes/​current/​oes_​stru.htm.
a  Based on the mean wages for 29-1229 Physicians and Surgeons, All Other.
b  Based on the mean wages for 29-9099 Other Healthcare Practitioners and Technical Occupations: Healthcare Practitioners and Technical Workers, All Other.
c  Based on an average of the mean wages for 29-1229 Physicians and Surgeons, All Other and 29-9099 Other Healthcare Practitioners and Technical Workers: Healthcare Practitioners and Technical Workers, All Other.