Contents

Document Production and Publication
   Clearance
   Surveys and Other Information Collection
   Printing and Duplication
   Coordination With the AHRQ Website
   Use of AHRQ Branding Design and Logos
   Proprietary Software

Disclaimers and Disclosures
  Copyright, Licensing Agreements, Trademarks, and Related Intellectual Property Requirements
   Federal Employees
   Grantees
   Contractors
   Licensing Agreements
   Using Copyrighted Content
   Providing Copyright Notices
   Indicating Trademarks and Trade Names

Public Access Policy

Authorship and Credit

Style, Use, and Punctuation
   Plain Language
   General Preferences
   Statistics
   Medical Terms
   Report Titles
   General Punctuation
   Bulleted Lists
   Hyphens
   Acronyms and Abbreviations
   Numerals
   Capitalization

References
   Citing Journals
   Citing Books
   Citing Scientific and Technical Reports From Government Agencies
   Citing Grant or Contract Reports
   Citing Web Pages
   Using Stock Photography

Submitting Documents to AHRQ

PowerPoint Presentations

Toolkits
   Checklists
   “Is This a Toolkit?” Checklist
   Toolkit Content Checklist
   Tool Checklist
   How To Present Your Toolkit on the Web

Additional Information

Appendixes

Appendix 1-A. Permission Forms
Appendix 1-B. Trademarks
Appendix 1-C. Video Submission Checklist (PDF, 935 KB)
Appendix 1-D. Standards for Contractors Developing Multimedia Products
Appendix 1-E. AHRQ Toolkit Component Formatting

This section includes guidance on clearance, surveys, printing and duplication, and posting on the AHRQ website. It also provides guidance on disclaimers, copyright permissions, and the use of AHRQ trademarks. It provides tips on editorial style and an overview of the editorial process that occurs once a document is received at AHRQ’s Office of Communications (OC). This section also provides instructions for PowerPoint presentations, audio and video products, and toolkits and includes general specifications for other documents.

Document Production and Publication

Clearance

Products that are newsworthy, controversial, or part of a public education campaign require a U.S. Department of Health and Human Services (HHS) clearance using an internal HHS platform called the Strategic Communications Plan. AHRQ has very few products that need Strategic Communication Plans; however, if a product does require one, the OC managing editor assigned to the product will assist with developing and then submitting the Strategic Communications Plan to HHS.

Surveys and Other Information Collection

Contractors who collect information from the public other than the minimum needed to provide a service must work through their AHRQ project officer to gain Office of Management and Budget (OMB) clearance for the information collection. OMB clearance is needed for information collection activities including: research projects (surveys, interviews, questionnaires, epidemiology studies, health risk factor assessments, program evaluations, focus groups) and administrative activities (forms, reporting requirements, program management functions, customer review and input). Clearance must be requested for any situation where 10 or more respondents are involved and the questions are standardized in nature. OMB approval is not needed for surveys of Federal employees.

AHRQ project officers must coordinate with the Agency's Paperwork Reduction Act officer to obtain the appropriate approvals. Currently, Doris Lefkowitz and Michelle Roberts serve that function for AHRQ.

OMB approval is needed to collect information or feedback from users for surveys or evaluations, regardless of how the information is collected (website, email, or paper). The contractor must post a notice at the point of collection with the OMB approval number and a statement on the process of collection.

Printing and Duplication

AHRQ purchases printing services through the Government Publishing Office. Contractors are not permitted to purchase printing services on behalf of the Federal Government.

With OC approval, contractors may make a limited number of copies of AHRQ documents. Quantities are not to exceed 25,000 impressions (i.e., the total number of pages; for example, five copies of a 100-page document equals 500 impressions). An OC managing editor must review the document before the contractor makes copies.

Coordination With the AHRQ Website

All AHRQ products must adhere to Section 2 of these guidelines, Web Products and Website Development and Redesign.

The OC managing editor will coordinate posting of web documents through AHRQ's web team and with AHRQ's program team for third-level domain websites. If you need to know who the managing editor is for a project or need a managing editor assigned to a project, contact Bruce Seeman.

Use of AHRQ Branding Design and Logos

AHRQ branding must be included on all AHRQ products, whether produced in-house or by a contractor.

• Samples of AHRQ design elements/logos are provided in Section 3 of these guidelines.
• Grantees may not include HHS or AHRQ logos on their products.
• Contractors must include the HHS/AHRQ logos and may not use contractor logos on AHRQ products, including materials in print, on websites, and in audiovisual media. The contractor's role may be acknowledged in the front matter of a report or toolkit or in a note at the bottom of a web page without the use of a logo.
• The HHS/AHRQ logo is only to be used on official, AHRQ-sponsored products.

In most cases, the AHRQ logo must be used with the HHS logo. The AHRQ logo may be used by itself as noted below:

• AHRQ’s logo may be used if other Federal agencies have provided their logo.
• The AHRQ logo may not be used in cases where it may be construed as an endorsement. The appropriate AHRQ official (e.g., Project Officer), not contractor personnel, will determine whether the logo may be used.
• Contractors may use the AHRQ logo alone for handouts, training materials, PowerPoint slides, and other materials only when conducting work on behalf of the Agency.

Proprietary Software

Contractors will not prepare products that require users to purchase a specific software program to access the information.

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Disclaimers and Disclosures

Contractors and grantees must use a disclaimer for products developed, respectively, under a contract or grant to indicate the limitations of AHRQ’s responsibility for the content of the report and any necessary cautions about its intended use. Contractors and grantees may adapt the disclaimer to suit the needs of the individual product. The AHRQ managing editor has to approve any changes.

A general disclaimer follows:

This project was funded under contract/grant number XXXX from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The authors are solely responsible for this document’s contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this product as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the authors has any affiliation or financial involvement that conflicts with the material presented in this product.

Public Availability Notice. This product is made publicly available by AHRQ and may be used and reprinted without permission in the United States for noncommercial purposes, unless materials are clearly noted as copyrighted in the document. No one may reproduce copyrighted materials without the permission of the copyright holders. Users outside the United States must get permission from AHRQ to reprint or translate this product. Anyone wanting to reproduce this product for sale must contact AHRQ for permission.

Copyright, Licensing Agreements, Trademarks, and Related Intellectual Property Requirements

Contractors and AHRQ project officers should work with OC managing editors to determine permissions needed for a project. At the end of a project, AHRQ project officers must deliver electronic copies of all signed permission agreements to OC. Sample forms for obtaining permissions are provided in Appendix 1-A (PDF portfolio, 3.6 MB).

The coordinator for matters involving copyright permissions is David Lewin.

Federal Employees

AHRQ staff who submit articles to journals for publication cannot assign copyright to the journal. Federal employees' work is not protected by the Copyright Act. The following statement is used if a Federal employment option is not provided on the journal's copyright form:

I was an employee of the U.S. Federal Government when this work was completed and prepared for publication. It is not protected under the Copyright Act, and the journal cannot claim copyright to the work.

Grantees

Grantees may copyright their work. However, the Federal Government has the right to use grantees' work for its own purposes, such as featuring grantee web-based resources. For additional guidance, grantees may refer to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, 45 CFR 75.322 (2014), and the HHS Grants Policy Statement, II-72 (2007).

Contractors

Contractors may not copyright products they create on behalf of AHRQ without AHRQ permission. Contract deliverables are the property of the Federal Government. For additional guidance, contractors may refer to clause 52.227-17 of the Federal Acquisition Regulation, "Rights in Data—Special Works."

Licensing Agreements

On rare occasions, AHRQ may agree to share rights to materials by negotiating a licensing agreement after AHRQ receives the deliverable. In these cases, contractors should consult the managing editor assigned to the project, who will work with AHRQ's attorney to draft the agreement and any needed disclaimers and licensing notices. Contractors and program staff should not create licensing agreements without AHRQ's attorney.

Using Copyrighted Content

Authors must consider copyright when reproducing others' work, including tables, figures, photographs, illustrations, slides, and videos. To use copyrighted material in an AHRQ publication, the author must obtain written permission from the copyright holder to reproduce the item and provide a copy of the permission to OC to retain in its permissions archive. Note that the copyright holder, often a journal or book publisher, may charge a fee to use the material. At a minimum, copyright holders will require the reprinted item to run with a statement, such as "Reprinted with permission from Reason J. Human Error. New York: Cambridge University Press, 1990, p.175."

If an author uses most of an original copyrighted work, he or she must request permission from the source to adapt the material. The item will appear with a statement that indicates AHRQ received permission to use the work. (“Adapted with permission from Donabedian A. Explorations in Quality Assessment and Monitoring: The Definition of Quality and Approaches to Its Assessment. Volume I. Ann Arbor, MI: Health Administration Press, 1980.”)

Authors need permission to reproduce photographs that are under copyright protection. Photos in the public domain (e.g., photos taken for the Federal Government's use or no longer copyrighted) do not need permission.

Web-based material is considered to be copyrighted immediately upon its creation, even if the site does not provide a copyright notice. Authors must obtain permission to reprint web material. Typically, websites offer an email address for this purpose; if no email address is available, authors must cite the website, the date of posting, if available, and the date of access.

Appendix 1-A provides a permission form (PDF, 575 KB) to request use of copyrighted items.

Providing Copyright Notices

Note copyrighted material, as follows:

• When an entire electronic document is copyrighted, the notice appears with the publication’s disclaimer referenced above.
• When copyrighted material pertains only to particular items within the document, an abbreviated copyright notice is placed directly under the copyrighted item. (Source: World Health Organization, 1990. Used with permission.)
• Include the complete citation for the source of the copyrighted material in the reference list. If a table or figure is compiled from data from a number of sources, each source should be listed in a footnote at the bottom of the item, and the complete citation should be included in the reference list. Indicate if the table or figure was adapted.

Reprinting of AHRQ publications without permission for commercial purposes is prohibited under the Social Security Act (42 United States Code 1320b-10): "2(B) No person may, for a fee, reproduce, reprint, or distribute any item consisting of a form, application, or other publication of the Department of Health and Human Services unless such person has obtained specific, written authorization for such activity in accordance with regulations which the Secretary shall prescribe."

Violators can be fined up to $5,000 per printed or electronic copy sold. Staff members, grantees, or contractors who find a commercial publisher or bookseller reprinting AHRQ-funded reports and selling them for a profit should notify OC.

AHRQ employees should consult with the HHS Office of the General Counsel before giving an opinion that the questioned commercial publication is in violation of this statute.

Indicating Trademarks and Trade Names

• Use the ™ or ^® symbols on first mention in each chapter and in major headings to reflect trademarks.
• Avoid using trade or brand names of drugs or products when possible. For a trademarked or brand name of a drug, use the generic name whenever possible. The Physicians’ Desk Reference^® lists generic names.
• For information about trademarks, see Appendix 1-B.

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Public Access Policy

The AHRQ Policy for Public Access to Publications requires that AHRQ-funded authors submit an electronic version of the author’s final peer-reviewed accepted manuscript to the National Library of Medicine’s PubMed Central (PMC) upon acceptance by the journal and that this electronic version be made publicly available within 12 months of the publisher’s date of publication.

This policy applies to AHRQ intramural researchers, extramural recipients of AHRQ grants and cooperative agreement awards, and AHRQ contractors conducting research. This policy applies to all peer-reviewed scientific publications arising from AHRQ funding. Implementation is prospective and does not apply to any publication arising from an AHRQ-funded grant, cooperative agreement award, or research contract funded prior to publication of the policy (February 19, 2016). However, AHRQ encourages researchers with publications resulting from AHRQ funding prior to publication of this policy to submit final manuscripts for public access.

The AHRQ policy applies to all research grants and career development award mechanisms, cooperative agreements, contracts conducting research, and Institutional and Individual National Research Service Awards, as well as AHRQ intramural research studies. In cases where AHRQ-funded research is administered or performed by a partner agency with a comparable public access policy, AHRQ will defer to the partner agency’s policies on the management of scientific publications. The policy requires that authors make their final manuscript publicly accessible as soon as possible, but no later than 12 months after the publisher’s official date of final publication.

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Authorship and Credit

A list of authors with their affiliations can appear in the front matter of a report.

Professional credentials are listed in the following order:

• Academic and professional degrees, with the highest ranked degree first
• Licenses or other State-issued designations
• Professional certifications
• Honors, including fellowships in honorary societies

As a general rule, no more than two credentials should be used in the AHRQ Views blog.

Acknowledgments of a specific substantive contribution an individual or organization made are optional. Short acknowledgments can be included in the front matter; longer lists of acknowledgments may warrant an appendix. AHRQ staff who worked on a product but are not authors may be included.

Acknowledgments may recognize contractor affiliation but cannot include the contractor logo. For example:

We thank John Doe, Ph.D., Professor of Environmental Health Sciences at the XXX School of Public Health, and Jane Smith, M.D., M.Sc., Associate Professor of Medicine at the XXX School of Medicine, for their valuable advice on this document.

Style, Use, and Punctuation

AHRQ follows the U.S. Government Publishing Office (GPO) Style Manual. Additional recommended style guides and dictionaries are:

• American Medical Association Manual of Style and Dorland’s Illustrated Medical Dictionary (for medical terms and usage).
• Publication Manual of the American Psychological Association (for data terms and usage).
• Associated Press Stylebook (for press releases and blogs).
• Webster’s Third New International Dictionary.

Plain Language

All written materials must be in compliance with the Plain Writing Act of 2010. The law requires that Federal agencies use create clear content that the public can understand and use.

Plain language means that the audience can understand the first time they read the product. Authors should refer to AHRQ's expectations and resources for plain language. In addition to training writers in plain language, product developers may need to use editors with expertise in plain language. Testing products with the target audience is the best way to ensure that products are easy to understand.

Before submitting products to AHRQ, developers should assess them using the checklists below.

A product is easier to understand when it:

• Makes the purpose of the product and each chapter or section evident at a glance.
• Presents information in a logical sequence.
• Does not include content that distracts from the product's purpose.
• Uses common, everyday language. (Refer to Plain Language at AHRQ).
• Uses active voice.
• Uses medical terms only to familiarize the audience with the terms and defines them.
• Includes clear definitions for technical terms when plain language equivalents cannot be used.

Formatting can also increase understanding. Product developers should check that the product:

• Breaks up content into short sections and provides subheads where appropriate.
• Uses visual cues (e.g., arrows, boxes, bullets, bold, larger font, highlighting) to draw attention to key points.
• Makes tables and other visual aids short and uncluttered, with clear titles or captions.
• Makes numbers clear and easy to understand.
• Provides summaries at appropriate points.

General Preferences

• Data. The word “data” takes a plural verb.
• Sex versus gender. “Sex” refers to male or female physical characteristics. “Gender” distinguishes masculine and feminine social roles, as well as other forms of gender identity (e.g., nonbinary, two spirit).
• People versus persons. “People”—not persons—is the plural of “person.”
• Comparisons. “Compared with,” not “compared to.”
• Use. Not utilize.
• Prevention. “Preventive” not “preventative.”

Statistics

• p-values. Use lower case regular (p<0.05).
• Confidence intervals. Use 95% CI, 3.0 to 6.1. This format makes it clear that the interval is a range; it also prevents confusion between negative signs and hyphens.
• Probabilities. When comparing probabilities, be precise. Use “[however many times] as likely” rather than “more likely,” “less likely,” or “very likely.” (Example: Say the odds of getting cancer = 5.7/1,000 for women and 17/1,000 for men. This means that men are about 3 times as likely to get cancer as women.)
• Comparisons. Report results in comparative terms to describe the magnitude of effect (units, relative risks, absolute terms). For example, if the risk of cancer in men is 3/1,000 and the risk in women is 6/1,000, then the relative risk for women is 2 (twice the risk in men).

Medical Terms

• Taxonomic terms are always italicized (e.g., Clostridioides difficile or C. difficile). Note that the term is spelled out at first use.
• Patients and study subjects should be described with humane language:
  • Diabetic patients or patients with diabetes, rather than diabetics.
  • The patient reported chest pain, rather than the patient complained of chest pain.

Report Titles

• Keep the title to a maximum of 10 words. A short subtitle is optional.
• Do not use abbreviations in titles unless spelling out a term would make the title too long or incomprehensible or if the audience is familiar with the abbreviation. Do not use both a spelled-out term and an abbreviation in a title.

General Punctuation

• Serial comma. For elements in a series, use a comma before the conjunctions “and,” “or,” and “nor” (e.g., dog, cat, and bird).
• Et al. Use a comma before “et al.” in a reference list (see below under References).

Bulleted Lists

• For a simple list consisting only of words or phrases, do not use periods at the end of the items:
  
  The store has three locations:
  • Silver Spring
  • Wheaton
  • Rockville
• If the list contains full sentences, include periods at the end of each item:
  
  The man noticed three things in the waiting room:
  • The clock was slow.
  • The plants needed to be watered.
  • The magazines were dated 1985.
• If one item in a list requires a period, all items get periods:
  
  The researchers were very interested in three topics:
  • Healthcare quality.
  • Grants.
  • The National Healthcare Disparities Report. The Agency for Healthcare Research and Quality publishes this report annually.

Hyphens

• Hyphenate the following words when used as modifiers.
  • Long-term care
  • Short-term memory
  • Up-to-date statistics
• Prefixes are not hyphenated in AHRQ style, unless the compound produces an ambiguous word or the original word is a proper noun; for example:
  • Anti (e.g., anticoagulant; but anti-inflammatory, anti-AIDS)
  • Co (e.g., codirector, but co-occurrence)
  • Non (e.g., nonopioid, but non-Hispanic)
  • Post (e.g., postsurgical, postmarketing; but post-test, post-Darwinian)
  • Pre (e.g., preterm)
  • Re (e.g., rebiopsy; but re-creation vs. recreation)
• The following appear as one word:
  • Database
  • Dataset
  • Email
  • Followup (one word if used as a noun, but two words if used as a verb, such as “the doctor will follow up with you in a few days”)
  • Healthcare
  • Online
  • Policymakers
  • Policymaking
  • Website
• Do not compound the following:
  • Quality of life, except when used as an adjective (quality-of-life outcomes).
  • Web conference, web page.

Acronyms and Abbreviations

• Define all abbreviations in the text at the first mention in each chapter or major report section (i.e., in the text but not the title).
• Use abbreviations judiciously. If a term is used fewer than three times, an abbreviation is not necessary.
• Follow the first use with the abbreviation in parentheses—for example, angiotensin-converting enzyme inhibitors (ACEIs).
• Include all acronyms and abbreviations in a key at the bottom of figures and tables.
• Spell out standard medical abbreviations—such as HbA1c (hemoglobin A1c), MRSA (methicillin-resistant Staphylococcus aureus)—at first use.
• Spell out “United States” when used as a proper noun. Use the abbreviation “U.S.” when used as an adjective.
• Distinguish between e.g. (an example from a larger class) and i.e. (an explanation of the term that has been described in the preceding phrase).
• Spell out “percent” in text, but use % in tables, figures, charts, graphs, and parentheses.

Numerals

• Use numerals for time, measurement, and money (e.g., 2-year followup, 4 weeks, 4 percent, 10 cm, $5 million) and for the number 10 and greater. Write out everything else (six cats, nine oranges, three ply, fivefold).
• Use numerals for ordinal numbers beginning with 10th.
• Use numerals in charts and parentheses (e.g., n=3 studies).

Capitalization

• Capitalize the following in text and headings:
  • Titles and subtitles of the report. Capitalize the following:
    • Prepositions with four or more letters (With, From, Between).
    • All 4-letter demonstrative pronouns (This, That).
    • All 2- and 3-letter verbal forms (To [in an infinitive], Am, Be, Is, Was, Has, Have).
    • Each word in a hyphenated term with initial caps (Off-Label Use of Drugs).
  • Web at the beginning of a sentence, otherwise lowercase (website and web address). Also lowercase webcast and webinar, as one word.
  • Capitalize offices and officers related to AHRQ programs when used as titles: e.g., John Doe, Project Officer; Mary Roe, Task Order Officer.
• Do not capitalize:
  • Federal, state, nation, federal government, tribe, or agency, except in proper nouns (e.g., Federal Reserve, New York State [but state of New York], Agency for Healthcare Research and Quality [the agency]).
  • Do not capitalize nationwide, statewide, local, or federally.
  • The words “syndrome” and “disease” (e.g., Prader-Willi syndrome, Paget disease).
  • Medical conditions (e.g., type 2 diabetes).

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