Information Collection Request

Evaluating the Implementation of PCOR to Increase Referral, Enrollment, and Retention through Automatic Referral to Cardiac Rehabilitation (CR) with Care Coordinator

ICR 202004-0935-002 · OMB 0935-0252 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 5 Attachment H – Learning Community Follow-up Survey Form and Instruction New Available
Form 4 Attachment G – Learning Community Participant Survey Form and Instruction New Available
Form 3 Attachment E – Interviews with Partner Hospital cardiologists Form and Instruction New Available
Form 2 Interviews with Partner Hospital Champions Form and Instruction New Available
Form 1 Attachment C – Partner Hospital Champion Survey Form and Instruction New Available
Attachment A. Acronyms (2020-01-08).docx Supplementary Document Uploaded 2020-04-14 Available
CR Supporting Statement Part A (2020-01-09).docx Supporting Statement A Uploaded 2020-04-14 Available
CR Supporting Statement Part B (2020-01-07).docx Supporting Statement B Uploaded 2020-04-14 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
241336 Attachment H – Learning Community Follow-up Survey Form and Instruction New
241335 Attachment G – Learning Community Participant Survey Form and Instruction New
241334 Attachment F – Interviews with Partner Hospitals that withdraw Instruction New
241333 Attachment E – Interviews with Partner Hospital cardiologists Form and Instruction New
241331 Interviews with Partner Hospital Champions Form and Instruction New
241312 Attachment C – Partner Hospital Champion Survey Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2023 36 Months From Approved
803 0 0
333 0 0
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 803 0 0 803 0 0
Annual Time Burden (Hours) 333 0 0 333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No