Information Collection

Shared Decision Making

IC 220531 under ICR 201403-2900-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Veteran SDM Questionnaire 03March2016.docx	Other-Veteran Telephone Script
Caregiver SDM Questionnaire 03March2016.docx	Other-Caregiver Telephone Script
Glossary - short 090215.docx	Other-Glossary
Phone Interview Contact Script 082515.docx	Other-Phone Interview Script
VA Shared Decision Making Generic Clearance - Taylor 111615.docx Generic Clearance Request	IC Document

IC Title:

Shared Decision Making

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Veteran Telephone Script	Veteran SDM Questionnaire 03March2016.docx	No	Paper Only
Other-Caregiver Telephone Script	Caregiver SDM Questionnaire 03March2016.docx	No	Paper Only
Other-Glossary	Glossary - short 090215.docx	No	Paper Only
Other-Phone Interview Script	Phone Interview Contact Script 082515.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	150	150
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Clearance Request	VA Shared Decision Making Generic Clearance - Taylor 111615.docx	03/10/2016

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