Clinician survey

Evaluation of the SHARE Approach Model

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0253 can be found here:

Documents and Forms

Document Name Document Type
Form 3 Clinician survey Form and Instruction
3 Post-training survey to assess experiences with SHARE tr Clinician Post-survey_Clean_3.18.2020.docx Form and Instruction
3 Pre-training clinician survey to assess prior experience Clinician Pre-survey_Clean_3.18.2020.docx Form and Instruction
3 Clinician survey to assess use of SHARE two months follo Clinician Pre-survey_Clean_3.18.2020.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Clinician survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	3	Post-training survey to assess experiences with SHARE training:	Clinician Post-survey_Clean_3.18.2020.docx	No	Fillable Fileable
Form and Instruction	3	Clinician survey to assess use of SHARE two months following training	Clinician Pre-survey_Clean_3.18.2020.docx	No	Fillable Fileable
Form and Instruction	3	Pre-training clinician survey to assess prior experience with SDM	Clinician Pre-survey_Clean_3.18.2020.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.