OMB.report

Federal forms, ICRs, and supporting documents

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 201403-2900-007 · OMB 2900-0770.

Documents and Forms
Document Name
Document Type
Other-guide/script
Other-guide/script
Other-Script
Other-Script
Other-guide/transcription
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

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
 
Modified
 
Voluntary
 

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

Health Health Care Services

 

11,356 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 11,356 0 0 0 0 11,356
Annual IC Time Burden (Hours) 1,165 0 0 0 0 1,165
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.