Information Collection

Pain Assessment Instruments Development Referral Form - Cspi, Cspi-so, Pspi-tp, Pspi-cp, Fce, Fame And Follow-up

IC 115643 under ICR 199107-0960-004 · OMB 0960-0479.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

PAIN ASSESSMENT INSTRUMENTS DEVELOPMENT REFERRAL FORM - CSPI, CSPI-SO, PSPI-TP, PSPI-CP, FCE, FAME AND FOLLOW-UP

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	SCREENING	No	No
Form	CSPI	No	No
Form	SO, PSPI-TP	No	No
Form	PSPI-CP	No	No
Form	ISPR	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	600	-3,310	3,910
Annual IC Time Burden (Hours)	2,400	13	2,387
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.