Information Collection Request

Evaluation of the SHARE Approach Model

ICR 202107-0935-004 · OMB 0935-0253 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 4 Audio recorded encounters Form and Instruction Modified Available
Form 4 Audio recorded encounters Form and Instruction Modified Repair queued
Form 2 Card survey (clinician) Form and Instruction Unchanged Available
Form 2 Card survey (clinician) Form and Instruction Unchanged Repair queued
Form 3 Clinician survey to assess use of SHARE two months following training Form and Instruction Unchanged Available
Form 3 Pre-training clinician survey to assess prior experience with SDM Form and Instruction Unchanged Available
Form 3 Post-training survey to assess experiences with SHARE training: Form and Instruction Unchanged Available
Form 3 Clinician survey Form and Instruction Unchanged Repair queued
Form 1 Card survey (patient) Form and Instruction Unchanged Available
Form 1 Attachment B – SHARE Approach evaluation clinician and staff surveys Form and Instruction Unchanged Repair queued
Justification.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-07-23 Repair queued
Supporting Statement Part A (6).docx Supporting Statement A Uploaded 2020-04-22 Repair queued
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 ModifiedAudio recorded encounters
241470 Audio recorded encounters Form and Instruction Modified
241469 Card survey (clinician) Form and Instruction UnchangedCard survey (clinician)
241469 Card survey (clinician) Form and Instruction Unchanged
241465 Clinician survey Form and Instruction UnchangedClinician survey to assess use of SHARE two months following training
241465 Clinician survey Form and Instruction UnchangedPre-training clinician survey to assess prior experience with SDM
241465 Clinician survey Form and Instruction UnchangedPost-training survey to assess experiences with SHARE training:
241465 Clinician survey Form and Instruction Unchanged
241462 Attachment B – SHARE Approach evaluation clinician and staff surveys Form and Instruction UnchangedCard survey (patient)
241462 Attachment B – SHARE Approach evaluation clinician and staff surveys Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2023 10/31/2023 10/31/2023
18,460 0 18,460
476 0 476
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 18,460 0 0 0 0
Annual Time Burden (Hours) 476 476 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No