Information Collection Request

Safety Program in Perinatal Care (SPPC)-II Demonstration Project

ICR 202105-0935-001 · OMB 0935-0246 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form J3 Qualitative semi-structured interviews with frontline staff Form and Instruction New Missing upstream
Form R DUA for AIM data Form and Instruction Unchanged Repair queued
Form N Self-administered implementation surveys with clinical staff at 30 months Form and Instruction Unchanged Repair queued
Form M Self-administered implementation surveys with clinical staff at 18 months Form and Instruction Unchanged Repair queued
Form L Self-administered implementation surveys with clinical staff at 6 months Form and Instruction Unchanged Repair queued
Form J3 Qualitative, semi-structured interviews with AIM Team Leads Form and Instruction Modified Repair queued
Form G Clinical staff self-administered baseline surveys Form and Instruction Unchanged Available
Form E AIM Team Lead self-administered baseline surveys Form Unchanged Repair queued
Form D c) Coaching calls Form Unchanged Repair queued
Form I Tracking attendance of facilitation sessions Form and Instruction Unchanged Repair queued
Form A Frontline staff rosters developed by AIM Team Leads Form Unchanged Repair queued
Form 1 Training of AIM Team Leads Form and Instruction Unchanged Available
Attachment T List of Stakeholder Panel Members.docx Supplementary Document Uploaded 2019-08-16 Repair queued
Attachment S -List of measures reported by hospitals for the AIM program.docx Supplementary Document Uploaded 2019-08-16 Repair queued
SPPC-II Dem Supporting Statement Part B Revised after OMB Comments - 12.16.20 clean with highlights.docx Supporting Statement B Uploaded 2021-05-28 Repair queued
Supporting Statement Part A-clean with highlights eb rev +cf 12.21.docx Supporting Statement A Uploaded 2021-06-02 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
247674 Focus group discussions with AIM Team Leads and frontline staff Instruction New
247673 Qualitative semi-structured interviews with frontline staff Form and Instruction New
237429 DUA for AIM data Form and Instruction Unchanged
237428 Self-administered implementation surveys with clinical staff at 30 months Form and Instruction Unchanged
237426 Self-administered implementation surveys with clinical staff at 18 months Form and Instruction Unchanged
237418 Self-administered implementation surveys with clinical staff at 6 months Form and Instruction Unchanged
237417 Qualitative, semi-structured interviews with AIM Team Leads Form and Instruction Modified
237416 Clinical staff self-administered baseline surveys Form and Instruction Unchanged
237413 AIM Team Lead self-administered baseline surveys Form Unchanged
237411 c) Coaching calls Form Unchanged
237409 Facilitation sessions Instruction Unchanged
237396 Tracking attendance of facilitation sessions Form and Instruction Unchanged
237395 Training of frontline clinical staff Instruction Unchanged
237394 Evaluation form for training of AIM Team Leads Instruction Unchanged
237393 Frontline staff rosters developed by AIM Team Leads Form Unchanged
237386 Training of AIM Team Leads Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 12/31/2023
86,671 86,621
54,693 54,659
0 0





Reginfo record details
16
table that charts list of burden
IC Title Form No. Form Name
AIM Team Lead self-administered baseline surveys E, F AIM Team Leads training workshop ,   Consent form
Clinical staff self-administered baseline surveys G, H e) Clinical staff self-administered baseline surveys ,   Consent form
DUA for AIM data R DUA for AIM data
Evaluation form for training of AIM Team Leads B Evaluation form for training of AIM Team Leads
Facilitation sessions
Focus group discussions with AIM Team Leads and frontline staff
Frontline staff rosters developed by AIM Team Leads A Frontline staff rosters developed by AIM Team Leads
Qualitative semi-structured interviews with frontline staff J3 Interview guide for qualitative interviews with AIM Team Leads & frontline staff (summer/fall 2021)
Qualitative, semi-structured interviews with AIM Team Leads J6, J5, J3 Attachment J1 Interview guide for qualitative interviews with AIM Team Leads, 3-4mo (revised) ,   Attachment J5 Handout 2 listing Tier 1 online modules (new) ,   Attachment J6 Interview guide for FGDs with AIM Team Leads & frontline staff (summer/fall 2022, new)
Self-administered implementation surveys with clinical staff at 18 months M, P Self-administered implementation surveys with clinical staff at 18 months ,   Consent form - Self-administered implementation surveys with clinical staff at 18 months
Self-administered implementation surveys with clinical staff at 30 months Q, N Self-administered implementation surveys with clinical staff at 30 months ,   Consent form - Self-administered implementation surveys with clinical staff at 30 months
Self-administered implementation surveys with clinical staff at 6 months L, O Self-administered implementation surveys with clinical staff at 6 months ,   Consent form - 6 months
Tracking attendance of facilitation sessions I Tracking attendance of facilitation sessions
Training of AIM Team Leads 1 Training of AIM Team Leads
Training of frontline clinical staff
c) Coaching calls D Coaching calls

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 86,671 86,621 0 50 0 0
Annual Time Burden (Hours) 54,693 54,659 0 34 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No