Information Collection Request

Evaluation of Learning Health Systems K12 Training Program

ICR 202006-0935-001 · OMB 0935-0255 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form D1 Appendix D1. HSA Survey Form New Available
Form C1 Appendix C1. PD Interview Guide Form New Available
Form B1 Appendix B1. HSA Interview Guide Form New Available
Form A1 Appendix A1. Scholar Interview Guide Form and Instruction New Available
2020-12513.pdf Supplementary Document Uploaded 2020-10-21 Available
AHRQ OMB Part B_5-18-20.docx Supporting Statement B Uploaded 2020-06-05 Available
AHRQ OMB Part A_5-18-20.docx Supporting Statement A Uploaded 2020-06-05 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
242180 Appendix D1. HSA Survey Form New
242179 Appendix C1. PD Interview Guide Form New
242176 Appendix B1. HSA Interview Guide Form New
242174 Appendix A1. Scholar Interview Guide Form and Instruction New

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
147 0 0
95 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 147 0 0 147 0 0
Annual Time Burden (Hours) 95 0 0 95 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No