TeamSTEPPS 3.0 Training Implementation and Assessment

Documents and Forms

Document Name Document Type
Form 1 TeamSTEPPS 3.0 Training Implementation and Assessment Form and Instruction
1 Baseline Survey Attachment A - Baseline Survey.docx Form and Instruction
1 Baseline Survey Attachment A - Baseline Survey.docx Form and Instruction
2 Post-Training Survey Attachment B - Post-Training Survey.docx Form and Instruction
2 Post-Training Survey Attachment B - Post-Training Survey.docx Form and Instruction
3 Followup Survey Attachment C - Followup Survey.docx Form and Instruction
3 Followup Survey Attachment C - Followup Survey.docx Form and Instruction
Attachment D - Advance invitation reminder notice - TY letter followup survey_DRAFT 11.22.23.docx Follow Up Survey Letters IC Document
Attachment D - Advance invitation reminder notice - TY letter followup survey_DRAFT 11.22.23.docx Follow Up Survey Letters IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	TeamSTEPPS 3.0 Training Implementation and Assessment	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Baseline Survey	Attachment A - Baseline Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Post-Training Survey	Attachment B - Post-Training Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Followup Survey	Attachment C - Followup Survey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,350	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,350	10,350
Annual IC Time Burden (Hours)	3,450	3,450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Follow Up Survey Letters	Attachment D - Advance invitation reminder notice - TY letter followup survey_DRAFT 11.22.23.docx	01/09/2024

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