Information Collection

ICARE DIALOGUES Registration for 8 sessions (OLAW/OD)

IC 245552 under ICR 202201-0925-002 · OMB 0925-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0740 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ICARE DIALOGUES Registration for 8 sessions (OLAW/OD)	Form and Instruction
Form 1 Registration Part 1 ICARE DIALOGUES Registration for 8 sessions (OLAW/OD)	Form and Instruction
Form 2 Registration Part 2 ICARE DIALOGUES Registration for 8 sessions (OLAW/OD)	Form and Instruction
1 Registration Part 1 Supporting Documents Registration Part 1.pdf	Form and Instruction
1 Registration Part 1 Supporting Documents Registration Part 1.pdf	Form and Instruction
2 Registration Part 2 Supporting Documents Registration Part 2 (1).pdf	Form and Instruction
2 Registration Part 2 Supporting Documents Registration Part 2 (1).pdf	Form and Instruction
CORRECTED ICARE Dialogues Registration clearance application Sessions 12 through 19.docx Sub study Request ICARE Dialogues Registration Sessions 12 -19	IC Document
CORRECTED ICARE Dialogues Registration clearance application Sessions 12 through 19.docx Sub study Request ICARE Dialogues Registration Sessions 12 -19	IC Document
Supporting Document emails to registrants.pdf email to registrant	IC Document
Supporting Document emails to registrants.pdf email to registrant	IC Document

IC Title:

ICARE DIALOGUES Registration for 8 sessions (OLAW/OD)

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Registration Part 1	Supporting Documents Registration Part 1.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	Registration Part 2	Supporting Documents Registration Part 2 (1).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Sub study Request ICARE Dialogues Registration Sessions 12 -19	CORRECTED ICARE Dialogues Registration clearance application Sessions 12 through 19.docx	02/02/2021
email to registrant	Supporting Document emails to registrants.pdf	02/02/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.