Sepsis Campaign Development: Round 2 Concept/Materials Testing for Healthcare Providers

CDC and ATSDR Health Message Testing System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Document Name Document Type
Sepsis Campaign Development: Round 2 Concept/Materials Testing for Healthcare Providers Form
Screenshots of the Sepsis Survey for Healthcare Professi A.R2 Sepsis HCP Survey Screenshots.pdf Form
Sepsis R2 Project Description_5.31.2017 - HCP.docx Project Description for Sepsis R2 Testing with HCP IC Document
Sepsis_R2 Incentive Justification_5.31.2017- HCP.docx Justification for the Proposed Incentive IC Document
C1.Visual with slogan_A.png Test Item C1. Visual with Slogan_A IC Document
C2.Visual with slogan_B.png Test Item C2. Visual with Slogan_B IC Document
C3.Visual with slogan_C.png Test Item C3. Visual with Slogan_C IC Document
C4.Visual with slogan_D.png Test Item C4. Visual with Slogan_D IC Document
C5.Visual with slogan_E.png Test Item C5. Visual with Slogan_E IC Document
C6.Sepsis_Print_Concept_A.pdf Test Item C6. Print Concept_A IC Document
C7.Sepsis_Print_Concept_B.pdf Test Item C7. Print Concept_B IC Document
C8.Sepsis_Print_Concept_C.pdf Test Item C8. Print Concept_C IC Document
C9.Sepsis Campaign Stimulus_TV Ads.docx Test Item C9. Campaign Stimulus_TV Ads IC Document
C10.HCP Sepsis flier for R2 testing_FINAL.docx Test Item C10. Sepsis Flier for R2 Testing IC Document
Sepsis R2_HMTSExpeditedReviewForm_v4 - HCP.pdf HMTS Form - Sepsus R2 Testing with HCP IC Document

Information Collection (IC) Details

IC Title:	Sepsis Campaign Development: Round 2 Concept/Materials Testing for Healthcare Providers	Agency IC Tracking Number:	0920-17AGZ

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	n/a	Screenshots of the Sepsis Survey for Healthcare Professionals	A.R2 Sepsis HCP Survey Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 462	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	462	462
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Project Description for Sepsis R2 Testing with HCP	Sepsis R2 Project Description_5.31.2017 - HCP.docx	06/05/2017
Justification for the Proposed Incentive	Sepsis_R2 Incentive Justification_5.31.2017- HCP.docx	06/05/2017
Test Item C1. Visual with Slogan_A	C1.Visual with slogan_A.png	06/05/2017
Test Item C2. Visual with Slogan_B	C2.Visual with slogan_B.png	06/05/2017
Test Item C3. Visual with Slogan_C	C3.Visual with slogan_C.png	06/05/2017
Test Item C4. Visual with Slogan_D	C4.Visual with slogan_D.png	06/05/2017
Test Item C5. Visual with Slogan_E	C5.Visual with slogan_E.png	06/05/2017
Test Item C6. Print Concept_A	C6.Sepsis_Print_Concept_A.pdf	06/05/2017
Test Item C7. Print Concept_B	C7.Sepsis_Print_Concept_B.pdf	06/05/2017
Test Item C8. Print Concept_C	C8.Sepsis_Print_Concept_C.pdf	06/05/2017
Test Item C9. Campaign Stimulus_TV Ads	C9.Sepsis Campaign Stimulus_TV Ads.docx	06/05/2017
Test Item C10. Sepsis Flier for R2 Testing	C10.HCP Sepsis flier for R2 testing_FINAL.docx	06/05/2017
HMTS Form - Sepsus R2 Testing with HCP	Sepsis R2_HMTSExpeditedReviewForm_v4 - HCP.pdf	06/05/2017

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