Information Collection

PACT Lab Caregiver and Patient Focus Groups; Point of Care (POC) Patient and Provider Focus Groups; Telehealth in the PADRECC: Veteran Focus Group; COMM Patient Survey; Office of Public Health Survey

IC 200294 under ICR 201107-2900-001 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
VISN11_Focus Groups_Patient Guide (2).docx	Other-guide/script
VISN11_Focus Groups_Caregiver Guide (2).docx	Other-guide/script
POC_Patient Script_Focus Grp Script_NOV 30.2011.docx	Other-Script
POC_Provider Script _Focus Grp Script_NOV 30.2011.docx	Other-Script
PADRECC_Veteran Focus Group Discussion Guide (v2).docx	Other-guide/transcription
VA Form 10-0526 The Continuity of Medication Management Patient Survey Comm Patient Survey 12_2011.docx Telephonic Survey	Form
Article and Volume Office of Public Health Gulf War Newsletter Survey Office of Public Health Newsletter Survey .docx To Be Determined	Form
Generic_Clearance_Submission_Point of Care_research.docx Assessing VHA patient and provider perceptions of Point of Care (POCr) Focus Groups	IC Document
Research Consent-10-1086-fill.pdf PADRECC Research Consent Form	IC Document
COMM sampling plan.docx The Continuity of Medication Management Sampling Plan	IC Document
VA Office of Public Health Newsletter Survey Submission_v2.docx VA Office of Public Health Newsletter Survey Submission	IC Document
VISN11_PACT DL_Focus Groups_Generic Clearance 11-7-11 Request (v3).docx PACT DL Focus Group Generic Request	IC Document
PADRECC_Focus Group Generic_Clearance_Request.docx PADRECC Focus Group Generic Clearance Request	IC Document
Generic_Request_COMM Patient Survey_final.docx Generic Request_COMM Patient Survey	IC Document
Generic_Clearance_Submission_Point of Care_research.docx Assessing VHA Patient and Provider Perceptions of Point of Care (POC) Focus Groups	IC Document
vha-10-3203-fill.pdf Consent for Use of Picture and/or Voice	IC Document
Recruitment Flyer sample draft.docx POC_Recruitment Flyer Sample draft	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

PACT Lab Caregiver and Patient Focus Groups; Point of Care (POC) Patient and Provider Focus Groups; Telehealth in the PADRECC: Veteran Focus Group; COMM Patient Survey; Office of Public Health Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-guide/script			VISN11_Focus Groups_Patient Guide (2).docx		No		Paper Only
Other-guide/script			VISN11_Focus Groups_Caregiver Guide (2).docx		No		Paper Only
Other-Script			POC_Patient Script_Focus Grp Script_NOV 30.2011.docx		No		Paper Only
Other-Script			POC_Provider Script _Focus Grp Script_NOV 30.2011.docx		No		Paper Only
Other-guide/transcription			PADRECC_Veteran Focus Group Discussion Guide (v2).docx		No		Paper Only
Form	VA Form 10-0526	The Continuity of Medication Management Patient Survey	Comm Patient Survey 12_2011.docx	Telephonic Survey	No		Paper Only
Form	Article and Volume Number of Newsletter	Office of Public Health Gulf War Newsletter Survey	Office of Public Health Newsletter Survey .docx	To Be Determined	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,356

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
Annual Number of Responses for this IC	11,356	11,356
Annual IC Time Burden (Hours)	1,165	1,165
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Assessing VHA patient and provider perceptions of Point of Care (POCr) Focus Groups	Generic_Clearance_Submission_Point of Care_research.docx	12/07/2011
PADRECC Research Consent Form	Research Consent-10-1086-fill.pdf	12/08/2011
The Continuity of Medication Management Sampling Plan	COMM sampling plan.docx	12/28/2011
VA Office of Public Health Newsletter Survey Submission	VA Office of Public Health Newsletter Survey Submission_v2.docx	02/02/2012
PACT DL Focus Group Generic Request	VISN11_PACT DL_Focus Groups_Generic Clearance 11-7-11 Request (v3).docx	01/10/2012
PADRECC Focus Group Generic Clearance Request	PADRECC_Focus Group Generic_Clearance_Request.docx	01/12/2012
Generic Request_COMM Patient Survey	Generic_Request_COMM Patient Survey_final.docx	01/12/2012
Assessing VHA Patient and Provider Perceptions of Point of Care (POC) Focus Groups	Generic_Clearance_Submission_Point of Care_research.docx	01/13/2012
Consent for Use of Picture and/or Voice	vha-10-3203-fill.pdf	01/13/2012
POC_Recruitment Flyer Sample draft	Recruitment Flyer sample draft.docx	01/13/2012

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