Information Collection

Assessment of Health Dept. Antibiotic Stewardship Roles and Activities

IC 219814 under ICR 201412-0920-011 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att. B Interview Guide.docx	Other-Interview Guide
Statement A HD-AS.docx Supporting Statement A	IC Document
Statement B HD-AS.docx Supporting Statement B	IC Document
Att. D Notification Email.docx Email Invitation	IC Document
Att. E Reminder Email.docx Email Reminder	IC Document
Att. A States_Local Listing.docx Jurisdiction for Participation	IC Document
Att. C Core Components of ASP.docx Core Components of Programs	IC Document

IC Title:

Assessment of Health Dept. Antibiotic Stewardship Roles and Activities

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview Guide			Att. B Interview Guide.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	Statement A HD-AS.docx	01/27/2016
Supporting Statement B	Statement B HD-AS.docx	01/27/2016
Email Invitation	Att. D Notification Email.docx	01/27/2016
Email Reminder	Att. E Reminder Email.docx	01/27/2016
Jurisdiction for Participation	Att. A States_Local Listing.docx	01/27/2016
Core Components of Programs	Att. C Core Components of ASP.docx	01/27/2016

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