PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Attachment B – SHARE Approach evaluation clinician and staff surveys
Unchanged
6000
200
0
Form and Instruction
1
Card survey (patient)
Audio recorded encounters
Modified
260
43
0
Form and Instruction
4
Audio recorded encounters
Card survey (clinician)
Unchanged
12000
200
0
Form and Instruction
2
Card survey (clinician)
Clinician survey
Unchanged
200
33
0
Form and Instruction
3
Post-training survey to assess experiences with SHARE training:
Form and Instruction
3
Pre-training clinician survey to assess prior experience with SDM
Form and Instruction
3
Clinician survey to assess use of SHARE two months following training
Total burden requested under this ICR:
18460
476
0
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