Information Collection

TeamSTEPPS in Primary Care Post-Training Survey

IC 212713 under ICR 201408-0935-002 · OMB 0935-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0222 can be found here:

Documents and Forms

Document Name Document Type
Form 1 TeamSTEPPS in Primary Care Post-Training Survey Form
1 TeamSTEPPS in Primary Care Post-Training Survey SSA questions.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	TeamSTEPPS in Primary Care Post-Training Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	TeamSTEPPS in Primary Care Post-Training Survey	SSA questions.docx		Yes	Yes	Fillable Fileable

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: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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