Information Collection

Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum

IC 222551 under ICR 202310-0935-001 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

2025-01-24 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum	Form and Instruction
Appendix A - _Focus Group Screener Guide.docx	Other-screener
Appendix A - _Focus Group Screener Guide.docx	Other-screener
Appendix C - Focus Group Feedback Sheet.docx	Other-Feedback
Appendix C - Focus Group Feedback Sheet.docx	Other-Feedback
2 2. Appendix B – Moderator Guide Appendix B - Moderator's Guide.docx	Form and Instruction
2 2. Appendix B – Moderator Guide Appendix B - Moderator's Guide.docx	Form and Instruction
Appendix D - List of Module naaes to be used in Focus Groups.docx 4. Appendix D – List of Module Names to be Used in Focus Groups	IC Document
Appendix D - List of Module naaes to be used in Focus Groups.docx 4. Appendix D – List of Module Names to be Used in Focus Groups	IC Document
Module 2 - Instructor Guide.pdf Module 2	IC Document
Module 2 - Instructor Guide.pdf Module 2	IC Document
Module 3 - Instructor Guide.pdf Module 3	IC Document
Module 3 - Instructor Guide.pdf Module 3	IC Document
Module 4 - Instructor Guide.pdf Module 4	IC Document
Module 4 - Instructor Guide.pdf Module 4	IC Document
Module 5 - Instructor Guide.pdf Module 5	IC Document
Module 5 - Instructor Guide.pdf Module 5	IC Document
Module 6 - Instructor Guide.pdf Module 6	IC Document
Module 6 - Instructor Guide.pdf Module 6	IC Document
Module_8.pdf Module 8	IC Document
Module_8.pdf Module 8	IC Document
Module 10 - Instructor Guide.pdf Module 10	IC Document
Module 10 - Instructor Guide.pdf Module 10	IC Document
Module 11 - Instructor Guide.pdf Module 11	IC Document
Module 11 - Instructor Guide.pdf Module 11	IC Document
OMB Cover Letter.doc Cover Memo	IC Document
OMB Cover Letter.doc Cover Memo	IC Document
TS LTC Generic Clearance Submission Form SS Part A.doc Supporting Statement A	IC Document
TS LTC Generic Clearance Submission Form SS Part A.doc Supporting Statement A	IC Document
TS for LTC OMB Supporting Statement Part B 7-18-16.docx Supporting Statement B	IC Document
TS for LTC OMB Supporting Statement Part B 7-18-16.docx Supporting Statement B	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Focus Groups on TeamSTEPPSÂ® for Long-Term Care Curriculum

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	Available Electronically?	Electronic Capability
Form and Instruction	2	2. Appendix B â 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

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 72

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
4. Appendix D â 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.