TeamSTEPPS in Primary Care Post-Training Survey

Evaluation of the Implementation of TeamSTEPPS in Primary Care Settings (ITS-PC)

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 TS Primary Care Settings_OMB_Attachment A_Post_Training_Survey_041217.docx Form

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Modified

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	TS Primary Care Settings_OMB_Attachment A_Post_Training_Survey_041217.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	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: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	600	450	150
Annual IC Time Burden (Hours)	200	150	50
Annual IC Cost Burden (Dollars)	0	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.