Form
	Approved 
OMB No. 0935-0179
Exp. Date 11/30/2020
	
	Public
	reporting burden for this collection of information is estimated to
	average 30
	minutes per response, the estimated time required to complete
	the survey. An agency may not conduct or sponsor, and a person
	is not required to respond to, a collection of information unless it
	displays a currently valid OMB control number.  Send
	comments regarding this burden estimate or any other aspect of
	this collection of information, including suggestions for reducing
	this burden, to: AHRQ Reports Clearance Officer Attention: PRA,
	Paperwork Reduction Project (0935-0179) AHRQ, 5600 Fishers Lane, #
	07W41A, Rockville, MD 20857.
	
	
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | Burn, Alexandra C | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-13 |