Conduct the Point-of-Care Research Questionnaire

ICR 201207-2900-003

OMB: 2900-0796

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2013-11-06
Supplementary Document
2013-11-06
Supplementary Document
2013-11-06
Supplementary Document
2013-11-06
Supplementary Document
2013-09-16
Supplementary Document
2013-09-16
Supplementary Document
2012-11-06
Supplementary Document
2012-09-06
Supporting Statement A
2013-11-06
Supporting Statement B
2013-11-06
IC Document Collections
ICR Details
2900-0796 201207-2900-003
Historical Active
VA
Conduct the Point-of-Care Research Questionnaire
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 11/08/2013
Retrieve Notice of Action (NOA) 08/12/2013
  Inventory as of this Action Requested Previously Approved
11/30/2016 36 Months From Approved
600 0 0
150 0 0
0 0 0

This data collection is authorized under the stated code (38 U.S.C. § 527: US Code - Section 527). This research study is funded by the VA to support one of the VAs 16 transformation initiatives (December 21, 2010 VA Strategic Plan Refresh 2011 – 2015). Initiative #16 specifically addresses Point-of-Care Research. The potential translation impact of Point-of-Care Research (POC-R) within VA is impressive in scope. The outcomes of this study will help with the implementation practices, design of educational materials and the overall approach for POC-R program development within the VA and will be useful to the larger clinical research community. The initial funded proposal was granted on October 1, 2011 for focus groups (Award 1I01CX000691-01).

US Code: 38 USC 527 Name of Law: Data Measurement and Evaluation of VA programs
  
None

Not associated with rulemaking

  78 FR 26 02/07/2013
78 FR 142 07/24/2013
No

1
IC Title Form No. Form Name
Point of Care Patient Questionnaire VA Form 10-10069 Research Questionnaire

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 600 0 0 600 0 0
Annual Time Burden (Hours) 150 0 0 150 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection for which all burden hours are considered an increase.

$425,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 crystal.rennie@va.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/12/2013


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