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Federal forms, ICRs, and supporting documents

Information Collection

Usability Testing of Virtual Reality for Opioid-Sparing Pain Management Among Diverse Patients (OC)

IC 243281 under ICR 201911-0910-015 · OMB 0910-0497.

Documents and Forms
Document Name
Document Type
Other-Screening Script
Other-Consent Form
Other-Testing Guide for Patients
Other-Interview Guide for HC Workers
Other-Initial Eligibility Screening
Other-HC Worker Recruitment Email
Other-Flyer - Invitation
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Usability Testing of Virtual Reality for Opioid-Sparing Pain Management Among Diverse Patients (OC) OC
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screening Script Recruitment and Eligbility Screening Script.docx Yes No Printable Only
Other-Consent Form Consent Form.docx Yes Yes Fillable Fileable
Other-Testing Guide for Patients Interview and Usability Testing Guide for Patients.docx Yes No Printable Only
Other-Interview Guide for HC Workers Interview Guide for Healthcare Workers.docx Yes No Printable Only
Other-Initial Eligibility Screening Email Initial Eligibility Screening Email.docx Yes No Printable Only
Other-HC Worker Recruitment Email Health Care Worker Recruitment Email.docx Yes No Printable Only
Other-Flyer - Invitation Flyer - Invitation to Participate.docx Yes No Printable Only

Health Health Care Services

 

40 0
   
Individuals or Households
 
   0 %

  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 40 0 40 0 0 0
Annual IC Time Burden (Hours) 50 0 50 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
OMB Approval Memo 0497 OMB Approval Memo for Usability Testing for VR 2020.docx 08/24/2020
IRB Letter IRB Determination Letter.pdf 08/24/2020
Terms of Clearance Terms of clearance.docx 08/27/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.