Assessment of Health Dept. Antibiotic Stewardship Roles and Activities

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.