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Pain Assessment Instruments Development Referral Form - Cspi, Cspi-so, Pspi-tp, Pspi-cp, Fce, Fame And Follow-up
PAIN ASSESSMENT INSTRUMENTS DEVELOPMENT REFERRAL FORM - CSPI, CSPI-SO, PSPI-TP, PSPI-CP, FCE, FAME AND FOLLOW-UP
OMB: 0960-0479
IC ID: 115643
OMB.report
SSA
OMB 0960-0479
ICR 199107-0960-004
IC 115643
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
PAIN ASSESSMENT INSTRUMENTS DEVELOPMENT REFERRAL FORM - CSPI, CSPI-SO, PSPI-TP, PSPI-CP, FCE, FAME AND FOLLOW-UP
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
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
Form
SCREENING
No
No
Form
CSPI
No
No
Form
SO, PSPI-TP
No
No
Form
PSPI-CP
No
No
Form
ISPR
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
600
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
600
0
-3,310
0
0
3,910
Annual IC Time Burden (Hours)
2,400
0
13
0
0
2,387
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.