Information Collection Request

ACCESS, EXCHANGE, AND USE OF SOCIAL DETERMINANTS OF HEALTH DATA IN CLINICAL NOTES

ICR 202103-0955-002 · OMB 0955-0021 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form C3 Synchronous Focus Group Questions for Clinicians and Healthcare Professionals Form New Missing upstream
Form C5 Synchronous Focus Group Questions for Patients and Care Partners (Spanish) Form New Missing upstream
Form B3 Prescreening Questionnaire for Patients and Care Partners (Spanish) Form New Repair queued
Form C1 Asynchronous Focus Group Questions for Clinicians and Healthcare Professionals Form New Missing upstream
Form C4 Synchronous Focus Group Questions for Patients and Care Partners Form New Missing upstream
Form C2 Asynchronous Focus Group Questions for Patients and Care Partners Form New Missing upstream
Form B1 Prescreening Questionnaire for Clinicians and Healthcare Professionals Form New Repair queued
Form B2 Prescreening Questionnaire for Patients and Care Partners Form New Repair queued
Final Supporting Statement A 10-28-2021.docx Supporting Statement A Uploaded 2021-10-28 Repair queued
Attachment D5. Final Synchronous Focus Group Consent-Patients and Care Partners (English).docx Supplementary Document Uploaded 2021-10-12 Repair queued
Attachment D4. Final Synchronous Focus Group Consent-Patient and Care Partners (Spanish).docx Supplementary Document Uploaded 2021-10-12 Repair queued
Attachment D3. Final Synchronous Focus Group Consent-Clinicians and Healthcare Professionals.docx Supplementary Document Uploaded 2021-10-12 Repair queued
Attachment D1. Final Asynchronous Focus Group Consent-Clinicians and Healthcare Professionals.docx Supplementary Document Uploaded 2021-10-12 Missing upstream
Attachment D2. Final Asynchronous Focus Group Consent-Patients and Care Partners.docx Supplementary Document Uploaded 2021-10-12 Repair queued
Final Supporting Statement B 8.9.21.docx Supporting Statement B Uploaded 2021-10-12 Repair queued

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
1,700 0
425 0
0 0





table that charts list of burden
  Total Request 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 1,700 0 0 1,700 0 0
Annual Time Burden (Hours) 425 0 0 425 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No