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

Focus Groups as Used by the Food and Drug Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0497 can be found here:

Documents and Forms

Document Name Document Type
Recruitment and Eligbility Screening Script.docx Other-Screening Script
Consent Form.docx Other-Consent Form
Interview and Usability Testing Guide for Patients.docx Other-Testing Guide for Patients
Interview Guide for Healthcare Workers.docx Other-Interview Guide for HC Workers
Initial Eligibility Screening Email.docx Other-Initial Eligibility Screening
Health Care Worker Recruitment Email.docx Other-HC Worker Recruitment Email
Flyer - Invitation to Participate.docx Other-Flyer - Invitation
0497 OMB Approval Memo for Usability Testing for VR 2020.docx OMB Approval Memo IC Document
IRB Determination Letter.pdf IRB Letter IC Document
Terms of clearance.docx Terms of Clearance IC Document

Information Collection (IC) Details

IC Title:	Usability Testing of Virtual Reality for Opioid-Sparing Pain Management Among Diverse Patients (OC)	Agency IC Tracking Number:	OC

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.