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Website portal for Submission of Supplemental Evidence and Data for Systematic Reviews
Online Submission Form for Supplemental Evidence and Data for Systematic Reviews for the Evidence-based Practice Center Program
OMB: 0935-0231
IC ID: 219252
OMB.report
HHS/AHRQ
OMB 0935-0231
ICR 201512-0935-002
IC 219252
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0231 can be found here:
2022-10-20 - Reinstatement without change of a previously approved collection
2019-06-26 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
Form 1
Website portal for Submission of Supplemental Evidence and Data for Systematic Reviews
Form and Instruction
1 Attachment B -- Website portal for Submission of Supplem
Attachment B --Online Submission Form.png
Form and Instruction
2 Attachment C – Optional Data Entry Form
Attachment C -- Optional_Data Entry Form.xlsx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Website portal for Submission of Supplemental Evidence and Data for Systematic Reviews
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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 and Instruction
1
Attachment B -- Website portal for Submission of Supplemental Evidence and Data for Systematic Reviews
Attachment B --Online Submission Form.png
Yes
Yes
Fillable Fileable
Form and Instruction
2
Attachment C – Optional Data Entry Form
Attachment C -- Optional_Data Entry Form.xlsx
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
70
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
90 %
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
70
0
70
0
0
0
Annual IC Time Burden (Hours)
18
0
18
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.