OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Advancing the Collection and Use of Patient –Reported Outcomes through Health Information Technology

IC 234239 under ICR 201708-0935-002 · OMB 0935-0124.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Advancing the Collection and Use of Patient –Reported Outcomes through Health Information Technology
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Attachment A. PROMIS Item Bank V2.0 Attachment A_Promis Items_112818.docx Yes Yes Fillable Fileable
Form and Instruction 2 Process Usage Worksheet (Patients) Attachment C_Patient Process Usage Worksheet_112818.docx Yes Yes Fillable Fileable
Form and Instruction 3 Attachment D: Process Usage Worksheet (Providers) Attachment D_Provider Process Usage Worksheet_112818.docx Yes Yes Fillable Fileable

Health Health Care Services

 

216 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 899 0 899 0 0 0
Annual IC Time Burden (Hours) 120 0 120 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment B: Training Materials Attachment B_Training Materials_112818.docx 11/29/2018
Supporting Statement Supporting Statement_112818.doc 11/29/2018
Cover Letter OMB Cover Letter.docx.doc 11/29/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.