Information Collection Request

Evaluation of the SHARE Approach Model

ICR 202004-0935-004 · OMB 0935-0253 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 4 Audio recorded encounters Form and Instruction New Available
Form 2 Card survey (clinician) Form and Instruction New Available
Form 3 Clinician survey to assess use of SHARE two months following training Form and Instruction New Available
Form 3 Pre-training clinician survey to assess prior experience with SDM Form and Instruction New Available
Form 3 Post-training survey to assess experiences with SHARE training: Form and Instruction New Available
Form 1 Card survey (patient) Form and Instruction New Available
Supporting Statement Part A (6).docx Supporting Statement A Uploaded 2020-04-22 Available
Supporting Statement Part B_LS.docx Supporting Statement B Uploaded 2020-04-21 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
241470 Audio recorded encounters Form and Instruction NewAudio recorded encounters
241469 Card survey (clinician) Form and Instruction NewCard survey (clinician)
241465 Clinician survey Form and Instruction NewClinician survey to assess use of SHARE two months following training
241465 Clinician survey Form and Instruction NewPre-training clinician survey to assess prior experience with SDM
241465 Clinician survey Form and Instruction NewPost-training survey to assess experiences with SHARE training:
241462 Attachment B – SHARE Approach evaluation clinician and staff surveys Form and Instruction NewCard survey (patient)

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2023 36 Months From Approved
18,460 0 0
476 0 0
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Attachment B – SHARE Approach evaluation clinician and staff surveys 1
Audio recorded encounters 4
Card survey (clinician) 2
Clinician survey 3, 3, 3 ,   ,  

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 18,460 0 0 18,460 0 0
Annual Time Burden (Hours) 476 0 0 476 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No