OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Field Test of SPPC-II Toolkit and Training Modules during Pilot Phase of SPPC-II Demonstration Project

IC 235532 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
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Field Test of SPPC-II Toolkit and Training Modules during Pilot Phase of SPPC-II Demonstration Project
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 Attachment E SPPC II Short Questionnaire Final Attachment E- SPPC-II short questionnaire v4 - 5.23.19 - clean.docx Yes Yes Fillable Fileable
Form and Instruction 1 Attachment B- Field Test Interview Guides Final Attachment B - Field Test Interview Guides_version - 5.23.19 - clean.docx Yes Yes Fillable Fileable
Form and Instruction 1 Attachment B – Field Test Interview Guides Attachment B - Field Test Interview Guides_version - 4.1.19 with OMB boxes.docx Yes Yes Fillable Fileable
Form and Instruction 2 Attachment E – SPPC-II Field Test - Short Questionnaire Attachment E- SPPC-II short questionnaire v4.docx Yes Yes Fillable Fileable

Health Health Care Services

 

32 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 32 0 32 0 0 0
Annual IC Time Burden (Hours) 17 0 17 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment A -- Healthcare Research and Quality Act of 1999 Attachment A - HRQA 1999- AHRQ Authorizing Legislation.pdf 03/29/2019
Attachment C – Field Test Oral Consent Form – Tier 1 Attachment C - Field Test OralConsent-JHU SOM_Tier I.docx 03/29/2019
Attachment D – Field Test Oral Consent Form – Tier 2 Attachment D - Field Test OralConsent-JHU SOM_Tier II.docx 03/29/2019
Attachment F – List of Stakeholder Panel Members Attachment F List of Stakeholder Panel Members.docx 03/29/2019
Cover Letter OMB Cover Letter-3.31.docx (003).doc 04/02/2019
Supporting Statement Part A Supporting Statement Part A -Pretesting Clearance 2017 - SPPCII Field Test eb.doc 03/29/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.