Information Collection

Instrument 3: Plan, Do, Study, Act (PDSA) Form & Tracker

IC 257324 under ICR 202502-0970-043 · OMB 0970-0605.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0605 can be found here:

Documents and Forms

Document Name Document Type
Instrument 3_Plan, Do, Study, Act (PDSA) Form & Tracker.Clean.docx Other-Form & Tracker
Instrument 3_Plan, Do, Study, Act (PDSA) Form & Tracker.Clean.docx Other-Form & Tracker

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Instrument 3: Plan, Do, Study, Act (PDSA) Form & Tracker	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Form & Tracker			Instrument 3_Plan, Do, Study, Act (PDSA) Form & Tracker.Clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 168	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: 75 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,904	1,904
Annual IC Time Burden (Hours)	476	476
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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