Pain Management ECHO Evaluation: Patient Perspective

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Document Name Document Type
Echo Interview Guide with cover.docx Other-Telephone Evaluation
Generice Submission_Pain Management ECHO Evaluation.doc Generic Request_Pain Management ECHO Evaluation: Patient Perspective IC Document
Patient Interview Invitation Letter.docx Invitation Letter IC Document
Patient Information Sheet.docx Patient Information Sheet IC Document

Information Collection (IC) Details

IC Title:	Pain Management ECHO Evaluation: Patient Perspective	Agency IC Tracking Number:	2900-0770

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
Other-Telephone Evaluation			Echo Interview Guide with cover.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Request_Pain Management ECHO Evaluation: Patient Perspective	Generice Submission_Pain Management ECHO Evaluation.doc	04/16/2018
Invitation Letter	Patient Interview Invitation Letter.docx	04/12/2018
Patient Information Sheet	Patient Information Sheet.docx	04/16/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.