OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum

IC 222551 under ICR 202501-0935-001 · OMB 0935-0179.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 2
Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum		 Form and Instruction
Form 2
2. Appendix B – Moderator Guide 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)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 No   Paper Only
Other-screener No   Paper Only
Other-Feedback No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 0 0 -72 0 0 72
Annual IC Time Burden (Hours) 0 0 -108 0 0 108
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
4. Appendix D – List of Module Names to be Used in Focus Groups 07/20/2016
Module 2 07/20/2016
Module 3 07/20/2016
Module 4 07/20/2016
Module 5 07/20/2016
Module 6 07/20/2016
Module 8 07/20/2016
Module 10 07/20/2016
Module 11 07/20/2016
Cover Memo 07/20/2016
Supporting Statement A 07/20/2016
Supporting Statement B 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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