Information Collection Request

Evaluation of Phase I Demonstrations of the Pharmacy Quality Alliance

ICR 200905-0935-001 · OMB 0935-0155 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #2 Survey of Pharmacists Form and Instruction New Available
Form Form #1 Demonstration Staff Interviews Form and Instruction New Available
Attachment H -- Advance Email To Demonstration Leaders 10-19-2009.doc Supplementary Document Uploaded 2009-11-04 Available
Supporting Statement Part B -- Evaluation of Phase I Demonstration 10-23-2009.doc Supporting Statement B Uploaded 2009-11-04 Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf Supplementary Document Uploaded 2009-05-01 Repair queued
Attachment G -- Reminder Letter 10-19-2009.doc Supplementary Document Uploaded 2009-11-04 Available
Attachment F -- Cover Letter 10-19-2009.doc Supplementary Document Uploaded 2009-11-04 Available
Attachment E -- Advance Letter 10-19-2009.doc Supplementary Document Uploaded 2009-11-04 Available
Supporting Statement Part A -- Evaluation of Phase I Demonstration 10-23-2009.doc Supporting Statement A Uploaded 2009-11-04 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
189081 Survey of Pharmacists Form and Instruction New
189080 Demonstration Staff Interviews 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 12 Months From Approved
405 0 0
226 0 0
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Demonstration Staff Interviews Form #1 Interview Guide for Demonstration Staff
Survey of Pharmacists Form #2 Survey of Pharmacists

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 405 0 0 405 0 0
Annual Time Burden (Hours) 226 0 0 226 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No