Information Collection Request

Assessing the Impact of the National Implementation of TeamSTEPPS Master Training Program

ICR 201507-0935-002 · OMB 0935-0170 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Training participant questionnaire Form and Instruction Modified Available
Form 2 Semi-structured interview Form and Instruction Modified Available
Supporting Statement Part B_v3_2015-09-10 Comment.docx Supporting Statement B Uploaded 2015-09-17 Available
Attachment G - 30 Day FRN.pdf Supplementary Document Uploaded 2015-07-15 Available
ATTACHMENT B--Logic Model of Post-TeamSTEPPS Master Training Patient Safety Activities and Outcomes by Participant Role-v2.docx Supplementary Document Uploaded 2014-03-20 Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf Supplementary Document Uploaded 2014-03-20 Available
ATTACHMENT F -- AHRQ NITS Informed Consent Form.docx Supplementary Document Uploaded 2010-07-09 Available
ATTACHMENT D -- Advance notice invitation reminder notices and thank you letters for training participant questionnaire-v2.docx Supplementary Document Uploaded 2014-03-20 Available
ATTACHMENT F -- AHRQ NITS Informed Consent Form-v2.docx Supplementary Document Uploaded 2014-03-20 Available
Supporting Statement Part A 2015-09-10 Comments.docx Supporting Statement A Uploaded 2015-09-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
193967 Training participant questionnaire Form and Instruction Modified
193966 Semi-structured interview Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2018 36 Months From Approved 12/31/2015
2,481 0 2,481
881 0 881
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Training participant questionnaire 1 Training participant questionnaire
Semi-structured interview 2 Semi-structured interview guide

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 2,481 2,481 0 0 0 0
Annual Time Burden (Hours) 881 881 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No