Information Collection Request

Technical Assistance for Health IT and Health Information Exchange in Medicaid and SCHIP

ICR 200805-0935-001 · OMB 0935-0137 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #3 Web-based seminar evaluations Form and Instruction New Available
Form Form #2 Workshop evaluations Form and Instruction New Available
Form Form #1 Needs Assessment Form and Instruction New Available
Supporting Statement Part B 4-21-2008.doc Supporting Statement B Uploaded 2008-04-28 Available
Attachment J_Thank you letter from Contractor final.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment I_Consent Form 04-14-08.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment H_Script for Agency contactors_final.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment G3_AHRQ magnet.jpg Supplementary Document Uploaded 2008-04-28 Available
Attachment G2_SHOWCARDs final.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment G1_Contractor cover letter for needs assessment_final.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment F7_Pilot cover letter final.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment F6_Topics for Needs Assessment Interview_final.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment F5_Resource List final.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment F4_FastFacts on AHRQ TA contract_AHRQ_OCKT approved final.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment F3_NASMD cover letter final.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment F2_ Contractor lead letter final.doc Supplementary Document Uploaded 2008-04-28 Available
Attachment F1_AHRQ cover letter_withsig.pdf Supplementary Document Uploaded 2008-04-28 Available
Attachment B_60 Day FR Notice -- Technical Assistance for HIT.pdf Supplementary Document Uploaded 2008-04-28 Available
Supporting Statement Part A 4-25-2008.doc Supporting Statement A Uploaded 2008-04-28 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
184801 Web-based seminar evaluations Form and Instruction New
184800 Workshop evaluations Form and Instruction New
184799 Needs Assessment Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2011 36 Months From Approved
315 0 0
258 0 0
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Needs Assessment Form #1 Needs Assessment
Workshop evaluations Form #2 Workshop evaluations
Web-based seminar evaluations Form #3 Web-based seminar evaluations

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 315 0 0 315 0 0
Annual Time Burden (Hours) 258 0 0 258 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No