Understanding Health System Approaches to Chronic Pain Management

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920 Member Checking (Validation) Session Interview Guide	Form and Instruction	New	Repair queued
Form 0920 Member Checking (Validation) Session Interview Guide	Form and Instruction	New	Repair queued
Form 0920- Case Studies Interview Guide	Form and Instruction	New	Repair queued
Form 0920- Case Studies Interview Guide	Form and Instruction	New	Repair queued
Form 0920- Health System Leaders Interview Guide	Form and Instruction	New	Repair queued
Form 0920- Health System Leaders Interview Guide	Form and Instruction	New	Repair queued
Form 0920- Patient Survey	Form and Instruction	New	Repair queued
Form 0920- Patient Survey	Form and Instruction	New	Repair queued
Form 0920- Primary Care Clinician Survey	Form and Instruction	New	Repair queued
Form 0920- Primary Care Clinician Survey	Form and Instruction	New	Available
Att. L Supplemental Information..docx	Supplementary Document	Uploaded 2022-02-14	Repair queued
Att. K Authorizing Legislation.docx	Supplementary Document	Uploaded 2022-02-14	Repair queued
SSB Chronic Pain 012722_Final.docx	Supporting Statement B	Uploaded 2022-02-14	Repair queued
SSA Chronic Pain 012722_Final.docx	Supporting Statement A	Uploaded 2022-02-14	Repair queued
Att. G Institutional Review Board (IRB) Documentation.pdf	Supplementary Document	Uploaded 2022-01-26	Repair queued
Att. H Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2022-01-26	Repair queued
Att. H1 Privacy Determination email.pdf	Supplementary Document	Uploaded 2022-01-26	Repair queued
Att. F Published 60-Day Federal Register Notice.pdf	Supplementary Document	Uploaded 2022-01-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
251286	Invitation/Follow up Email	Instruction	New
251285	Member Checking (Validation) Session Interview Guide	Form and Instruction	New	Member Checking (Validation) Session Interview Guide
251285	Member Checking (Validation) Session Interview Guide	Form and Instruction	New
251284	Case Studies Interview Guide	Form and Instruction	New	Case Studies Interview Guide
251284	Case Studies Interview Guide	Form and Instruction	New
251283	Health System Leaders Interview Guide	Form and Instruction	New	Health System Leaders Interview Guide
251283	Health System Leaders Interview Guide	Form and Instruction	New
251282	Patient Survey	Form and Instruction	New	Patient Survey
251282	Patient Survey	Form and Instruction	New
251281	Primary Care Clinician Survey	Form and Instruction	New	Primary Care Clinician Survey
251281	Primary Care Clinician Survey	Form and Instruction	New

ICR Details

OMB Control No: 0920-1374	ICR Reference No: 202201-0920-014
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-21IE
Title: Understanding Health System Approaches to Chronic Pain Management
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/05/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/17/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2025	36 Months From Approved
Responses	6,004	0	0
Time Burden (Hours)	577	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of this formative research study is to obtain an enhanced understanding of the effects of policies and evidence-based guidelines related to chronic pain management and opioid prescribing, including access to medications for opioid use disorder (MOUD), for patients and clinicians in primary care settings among a diverse sample of health systems.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 53313	09/27/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 8253	02/14/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Case Studies Interview Guide	0920-	Case Studies Interview Guide
Health System Leaders Interview Guide	0920-	Health System Leaders Interview Guide
Invitation/Follow up Email
Member Checking (Validation) Session Interview Guide	0920	Member Checking (Validation) Session Interview Guide
Patient Survey	0920-	Patient Survey
Primary Care Clinician Survey	0920-	Primary Care Clinician Survey

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ICR Summary of Burden

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	6,004	0	0	6,004	0	0
Annual Time Burden (Hours)	577	0	0	577	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Request for a new OMB Control Number.

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Annual Cost to Federal Government: $811,216

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/17/2022

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