Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

OMB: 0935-0179

IC ID: 222551

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-screener
Other-screener
Other-Feedback
Other-Feedback
Form and Instruction
Form and Instruction
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IC Document
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IC Document
IC Document
IC Document
IC Document
IC Document
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IC Document
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IC Document
IC Document
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Information Collection (IC) Details

View Information Collection (IC)

Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 2. Appendix B – Moderator Guide Appendix B - Moderator's Guide.docx No   Paper Only
Other-screener Appendix A - _Focus Group Screener Guide.docx No   Paper Only
Other-Feedback Appendix C - Focus Group Feedback Sheet.docx No   Paper Only

Health Health Care Services

 

72 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 72 0 0 0 0 72
Annual IC Time Burden (Hours) 108 0 0 0 0 108
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
4. Appendix D – List of Module Names to be Used in Focus Groups Appendix D - List of Module naaes to be used in Focus Groups.docx 07/20/2016
Module 2 Module 2 - Instructor Guide.pdf 07/20/2016
Module 3 Module 3 - Instructor Guide.pdf 07/20/2016
Module 4 Module 4 - Instructor Guide.pdf 07/20/2016
Module 5 Module 5 - Instructor Guide.pdf 07/20/2016
Module 6 Module 6 - Instructor Guide.pdf 07/20/2016
Module 8 Module_8.pdf 07/20/2016
Module 10 Module 10 - Instructor Guide.pdf 07/20/2016
Module 11 Module 11 - Instructor Guide.pdf 07/20/2016
Cover Memo OMB Cover Letter.doc 07/20/2016
Supporting Statement A TS LTC Generic Clearance Submission Form SS Part A.doc 07/20/2016
Supporting Statement B TS for LTC OMB Supporting Statement Part B 7-18-16.docx 07/20/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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