Information Collection Request

Assessing the Impact of the Patient Safety Improvement Corps (PSIC) Training Program

ICR 200807-0935-003 · OMB 0935-0145 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #3 Qualitative Interview Form and Instruction New Available
Form Form #2 Organizational Leader Questionnaire Form and Instruction New Available
Form Form #1 Training participant questionnaire Form and Instruction New Available
AHRQ PSIC passback.doc Supplementary Document Uploaded 2008-11-04 Available
Attachment G -- Semi-structured interview guide_10-29-08.doc Supplementary Document Uploaded 2008-11-04 Available
Attachment D -- PSIC leadership questionnaire 10-29-08.doc Supplementary Document Uploaded 2008-11-04 Available
Attachment C -- PSIC participant questionnaire 10-29-08.doc Supplementary Document Uploaded 2008-11-04 Available
Supporting Statement Part B_PSIC Evaluation_10-29-08(2).doc Supporting Statement B Uploaded 2008-11-04 Available
Attachment B -- Logic Model_06.09.08_for RESUBMISSION.doc Supplementary Document Uploaded 2008-11-04 Available
Attachment H -- AHRQ PSIC Informed Consent Form_07-14-08.doc Supplementary Document Uploaded 2008-11-04 Available
30 Day FRN Amendment -- Assessing the Impact of the PSIC Training.pdf Supplementary Document Uploaded 2008-07-21 Available
Attachment I -- 60 Day FRN -- Assessing the Impact of the Patient safety Improvement Corps (PSIC) Training Program_4-16-08.pdf Supplementary Document Uploaded 2008-07-21 Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf Supplementary Document Uploaded 2008-06-24 Available
Attachment F -- AHRQ PSIC Leadership -- All Letters 06-24-08.doc Supplementary Document Uploaded 2008-11-04 Available
Attachment E -- AHRQ PSIC Participant -- All Letters 06-24-08.doc Supplementary Document Uploaded 2008-11-04 Available
Supporting Statement Part A_PSIC Evaluation_ 11-4-08.doc Supporting Statement A Uploaded 2008-11-04 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
185949 Qualitative Interview Form and Instruction New
185948 Organizational Leader Questionnaire Form and Instruction New
185947 Training participant questionnaire Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2010 18 Months From Approved
429 0 0
223 0 0
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Training participant questionnaire Form #1 Training participant questionnaire
Organizational Leader Questionnaire Form #2 Organizational leader questionnaire
Qualitative Interview Form #3 Semi-structured interview guide

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 429 0 0 429 0 0
Annual Time Burden (Hours) 223 0 0 223 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No