Physicians

Palliative Care: Conversations Matter Phase Two Evaluation (NINR)

Documents and Forms

Document Name Document Type
Form 1 Physicians Form and Instruction
1 PRE AND POST SURVEYS Attachment 2_Pre and Post Surveys_Screenshots.pdf Form and Instruction
Attachment 1_Pre and Post Surveys_Word Version.doc Attachment 1_Pre and Post Surveys_Word Version IC Document

Information Collection (IC) Details

IC Title:	Physicians	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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 and Instruction	1	PRE AND POST SURVEYS	Attachment 2_Pre and Post Surveys_Screenshots.pdf		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: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-300	300
Annual IC Time Burden (Hours)	-100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 1_Pre and Post Surveys_Word Version	Attachment 1_Pre and Post Surveys_Word Version.doc	08/29/2013

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