OMB control number

Demonstration of Health Literacy Universal Precautions Toolkit

OMB 0935-0202 · HHS/AHRQ.

OMB 0935-0202

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form Form #17 Practice Staff Member Interview - Post-implementation	Form and Instruction
Form Form #16 Health Literacy Team Member Interview - Post-implementation	Form and Instruction
Form Form #15 Health Literacy Team Leader Interview - Post-implementation	Form and Instruction
Form Form #14 Health Literacy Team Leader Interview - Pre-implementation	Form and Instruction
Form Form #13 Check-in Phone Calls	Form and Instruction
Form Form #12 Health Literacy Team Leader Survey - Post-implementation	Form and Instruction
Form Form #11 Health Literacy Team Leader Survey - Pre-implementation	Form and Instruction
Form Form #10 Practice Staff Survey - Post-implementation	Form and Instruction
Form Form #9 Practice Staff Survey - Pre-implementation	Form and Instruction
Form Form #8 Medication Review Form	Form and Instruction
Form Form #7 Survey Using Items from the Consumer Assessment of Healthcare Providers and Systems (CAHPS)	Form and Instruction
Form Form #6 Patient Survey	Form and Instruction
Form Form #5 Webinar/Orientation	Form and Instruction
Form Form #4 Implementation Tracking Form	Form and Instruction
Form Form #3 Health Literacy Assessment Questions	Form and Instruction
Form Form #2 Follow-up Recruitment Calls	Form and Instruction
Form Form #1 Practice Screening Calls	Form and Instruction
Supporting Statement Part B--Demonstration of Health Literacy Precautions Toolkit 09-14-2012.doc	Supporting Statement B
Attachment V -- Federal Register Notice.pdf	Supplementary Document
Attachment P -- Consent Form.doc	Supplementary Document
Attachment H -- Project Team Review of Practice HL Environment.docx	Supplementary Document
Attachment B -- Recruitment Email.docx	Supplementary Document
Attachment A -- Health Literacy Universal Precautions Toolkit.pdf	Supplementary Document
Attachment I.3 -- Patient Survey Cover memo-Paper.docx	Supplementary Document
Attachment I.2 -- Patient Survey Cover Memo-Tablet.docx	Supplementary Document
Supporting Statement Part A--Demonstration of Health Literacy Precautions Toolkit 09-14-2012.doc	Supporting Statement A
Practice Staff Member Interview - Post-implementation	Form and Instruction
Health Literacy Team Member Interview - Post-implementation	Form and Instruction
Health Literacy Team Leader Interview - Post-implementation	Form and Instruction
Health Literacy Team Leader Interview - Pre-implementation	Form and Instruction
Check-in Phone Calls	Form and Instruction
Health Literacy Team Leader Survey - Post-implementation	Form and Instruction
Health Literacy Team Leader Survey - Pre-implementation	Form and Instruction
Practice Staff Survey - Post-implementation	Form and Instruction
Practice Staff Survey - Pre-implementation	Form and Instruction
Medication Review Form	Form and Instruction
Survey Using Items from the Consumer Assessment of Healthcare Providers and Systems (CAHPS)	Form and Instruction
Patient Survey	Form and Instruction
Webinar/Orientation	Form and Instruction
Implementation Tracking Form	Form and Instruction
Health Literacy Assessment Questions	Form and Instruction
Follow-up Recruitment Calls	Form and Instruction
Practice Screening Calls	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201205-0935-003	New collection (Request for a new OMB Control Number)	2012-05-31		Approved with change