Supporting and Evaluation the Dissemination and Implementation of PCOR to Improve Non-Surgical Treatment of Urinary Incontinence Among Women in Primary Care

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 Interview Protocol	Form and Instruction	New	Available
Form 2 Practice Leader/Staff Semi-Structured Interviews	Form and Instruction	New	Repair queued
Form 1 Focus Group Protocol	Form and Instruction	New	Available
Form 1 Practice Facilitator Focus Groups	Form and Instruction	New	Repair queued
Supporting Statement Part B_MUI Evaluation_2022 08 16.docx	Supporting Statement B	Uploaded 2023-01-23	Repair queued
Supporting Statement Part A_MUI Evaluation_2022-revised_20Oct22.docx	Supporting Statement A	Uploaded 2023-01-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
258006	Practice Leader/Staff Semi-Structured Interviews	Form and Instruction	New	Interview Protocol
258006	Practice Leader/Staff Semi-Structured Interviews	Form and Instruction	New
258005	Practice Facilitator Focus Groups	Form and Instruction	New	Focus Group Protocol
258005	Practice Facilitator Focus Groups	Form and Instruction	New

ICR Details

OMB Control No: 0935-0264	ICR Reference No: 202301-0935-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Supporting and Evaluation the Dissemination and Implementation of PCOR to Improve Non-Surgical Treatment of Urinary Incontinence Among Women in Primary Care
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: 03/01/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/23/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	36 Months From Approved
Responses	90	0	0
Time Burden (Hours)	90	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This ICR addresses important gaps in urinary incontinence (UI) care for women in the primary care setting. Urinary incontinence (UI) is a highly prevalent condition among women: Studies in the US indicate that nearly 50 percent of women 40 years of age and older report symptoms consistent with UI.

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Authorizing Statute(s): US Code: 42 USC 299b-2 Name of Law: Health Care Quality Act of 1999
  

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:
	87 FR 208	10/28/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 11	01/18/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Practice Facilitator Focus Groups	1	Focus Group Protocol
Practice Leader/Staff Semi-Structured Interviews	2	Interview Protocol

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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	90	0	0	90	0	0
Annual Time Burden (Hours)	90	0	0	90	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: This is a new Information Collection Request

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Annual Cost to Federal Government: $129,967

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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.     No

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.     No

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: 01/23/2023

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