Information Collection

Assessment of a Pharmacist-Led Transition of Care Service Utilizing an Admissions Enhanced, Patient Risk Evaluation Approach: the ICARE Program

IC 251449 under ICR 202205-0910-005 · OMB 0910-0847.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0847 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Consent Form_PRA 2.8.22.docx	Other-Survey Instrument: Consent For
Consent Form_PRA 2.8.22.docx	Other-Survey Instrument: Consent For
Pre-implementation Provider Perception and Demand Survey 2.2.22.docx	Other-Survey Instrument: Pre-impleme
Pre-implementation Provider Perception and Demand Survey 2.2.22.docx	Other-Survey Instrument: Pre-impleme
12- and 18-month Provider Survey 2.8.22.docx	Other-Survey Instrument: 12- and 18-
12- and 18-month Provider Survey 2.8.22.docx	Other-Survey Instrument: 12- and 18-
Provider Perception EAMC IRB approval_signed.pdf	Other-Other: Signed IRB Approval
Provider Perception EAMC IRB approval_signed.pdf	Other-Other: Signed IRB Approval
OMB Memo 0847 Assessment Pharmacist Led TOC_2.10.22.docx 0847 OMB Approval Memo - Assessment of a Pharmacist-Led Transitions of Care Services Utilizing an Admissions Enhanced Patient Ri	IC Document
OMB Memo 0847 Assessment Pharmacist Led TOC_2.10.22.docx 0847 OMB Approval Memo - Assessment of a Pharmacist-Led Transitions of Care Services Utilizing an Admissions Enhanced Patient Ri	IC Document

IC Title:

Assessment of a Pharmacist-Led Transition of Care Service Utilizing an Admissions Enhanced, Patient Risk Evaluation Approach: the ICARE Program

Agency IC Tracking Number:

CDER

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Instrument: Consent Form	Consent Form_PRA 2.8.22.docx	Yes	Yes	Fillable Fileable
Other-Survey Instrument: Pre-implementation Provider Perception and Demand Survey	Pre-implementation Provider Perception and Demand Survey 2.2.22.docx	Yes	Yes	Fillable Fileable
Other-Survey Instrument: 12- and 18-month Provider Survey	12- and 18-month Provider Survey 2.8.22.docx	Yes	Yes	Fillable Fileable
Other-Other: Signed IRB Approval	Provider Perception EAMC IRB approval_signed.pdf	No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	450	450
Annual IC Time Burden (Hours)	37	37
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0847 OMB Approval Memo - Assessment of a Pharmacist-Led Transitions of Care Services Utilizing an Admissions Enhanced Patient Risk Evaluation Approach: the ICARE Program	OMB Memo 0847 Assessment Pharmacist Led TOC_2.10.22.docx	02/10/2022

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