OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract

IC 241698 under ICR 202501-0935-001 · OMB 0935-0179.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 1
Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract		 Form and Instruction
Form 1
Appendix A Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract		 Form and Instruction
Form 2
Appendix B Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract		 Form and Instruction
Form 3
Appendix C Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract		 Form and Instruction
Form 4
Appendix D Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract		 Form and Instruction
Form 5
Appendix E Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract		 Form and Instruction
Form 6
Appendix F Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract		 Form and Instruction
Form 7
Appendix Stakeholder Interviews for Task 4 of AHRQ's ACTION III Diagnostic Safety Capacity Building Contract		 Form and Instruction
1 Appendix A
Appendix A.docx 		Form and Instruction
1 Appendix A
Appendix A.docx 		Form and Instruction
2 Appendix B
Appendix B.docx 		Form and Instruction
2 Appendix B
Appendix B.docx 		Form and Instruction
3 Appendix C
Appendix C.docx 		Form and Instruction
3 Appendix C
Appendix C.docx 		Form and Instruction
4 Appendix D
Appendix D.docx 		Form and Instruction
4 Appendix D
Appendix D.docx 		Form and Instruction
5 Appendix E
Appendix E.docx 		Form and Instruction
5 Appendix E
Appendix E.docx 		Form and Instruction
6 Appendix F
Appendix F.docx 		Form and Instruction
6 Appendix F
Appendix F.docx 		Form and Instruction
7 Appendix
Appendix G.docx 		Form and Instruction
7 Appendix
Appendix G.docx 		Form and Instruction
Fast Track Template_4.21.20_final draft v3.docx
Supporting Statement		IC Document
Fast Track Template_4.21.20_final draft v3.docx
Supporting Statement		IC Document
Supporting Statement Detailed.docx
Detailed Supporting Statement		IC Document
Supporting Statement Detailed.docx
Detailed Supporting Statement		IC Document
OMB Cover Letter (4).docx
Cover Letter		IC Document
OMB Cover Letter (4).docx
Cover Letter		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 1 No   Paper Only
Form and Instruction 2 No   Paper Only
Form and Instruction 3 No   Paper Only
Form and Instruction 4 No   Paper Only
Form and Instruction 5 No   Paper Only
Form and Instruction 6 No   Paper Only
Form and Instruction 7 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 -680 0 0 680
Annual IC Time Burden (Hours) 0 0 -565 0 0 565
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Supporting Statement 05/05/2020
Detailed Supporting Statement 05/05/2020
Cover Letter 05/05/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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