Information Collection

TeamSTEPPS 3.0 Training Implementation and Assessment

IC 264334 under ICR 202312-0935-001 · OMB 0935-0267.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 TeamSTEPPS 3.0 Training Implementation and Assessment	Form and Instruction
1 Baseline Survey Attachment A - Baseline Survey.docx	Form and Instruction
1 Baseline Survey Attachment A - Baseline Survey.docx	Form and Instruction
2 Post-Training Survey Attachment B - Post-Training Survey.docx	Form and Instruction
2 Post-Training Survey Attachment B - Post-Training Survey.docx	Form and Instruction
3 Followup Survey Attachment C - Followup Survey.docx	Form and Instruction
3 Followup Survey Attachment C - Followup Survey.docx	Form and Instruction
Attachment D - Advance invitation reminder notice - TY letter followup survey_DRAFT 11.22.23.docx Follow Up Survey Letters	IC Document
Attachment D - Advance invitation reminder notice - TY letter followup survey_DRAFT 11.22.23.docx Follow Up Survey Letters	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Baseline Survey	Attachment A - Baseline Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Post-Training Survey	Attachment B - Post-Training Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Followup Survey	Attachment C - Followup Survey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,350	10,350
Annual IC Time Burden (Hours)	3,450	3,450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Follow Up Survey Letters	Attachment D - Advance invitation reminder notice - TY letter followup survey_DRAFT 11.22.23.docx	01/09/2024

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