Information Collection

Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Health Care Professionals

IC 227266 under ICR 201502-0920-001 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Health Care Professionals	Form and Instruction
Screener for Health Care Professionals Attach 2_HCP Screener FINAL 062117.doc	Form and Instruction
Pre-Discussion Information Survey for Health Care Profes Attach 3_HCP PDIS FINAL 062117.doc	Form and Instruction
In-Depth Interview Guide for Health Care Professionals Attach 4_HCP IDI Guide FINAL 062117.docx	Form and Instruction
1.Conversation Starters_FINAL 04.21.17.docx Test Item 1. Conversation Starters	IC Document
2.AU PSA Print Ad_Safe Play.pdf Test Item 2. Print Ad_Safe Play	IC Document
3.AU PSA Print Ad_Status Update.pdf Test Item 3. Print Ad_Status Update	IC Document
4.AU PSA Print Ad_The Right Tool.pdf Test Item 4. Print Ad_The Right Tool	IC Document
5.AU Campaign Stimulus_TV Ads.docx Test Item 5. Campaign Stimulus_TV Ads	IC Document
6.Visual with slogan_A.png Test Item 6. Visual with slogan_A	IC Document
7.Visual with slogan_B.png Test Item 7. Visual with slogan_B	IC Document
8.Visual with slogan_C.png Test Item 8. Visual with slogan_C	IC Document
9.Visual with slogan_D.jpg Test Item 9. Visual with slogan_D	IC Document
10.Visual with slogan_E.jpg Test Item 10. Visual with slogan_E	IC Document
Attach 1_AU R2 HCP Project Desc and Burden_062117.docx Project Description	IC Document
HMTS Expedited Review Form - AU R2 Campaign - HCPs 062017.pdf HMTS Expedited Review Form (AU R2/HCP)	IC Document
Attach 5_Verbal Consent IDI-FG FINAL 062117.docx Verbal Consent	IC Document
Attach 6_Observer Confidentiality_FINAL 062117.doc Observer Confidentiality Agreement	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Health Care Professionals

Agency IC Tracking Number:

0920-17ATJ

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	Available Electronically?	Electronic Capability
Form and Instruction	n/a	Screener for Health Care Professionals	Attach 2_HCP Screener FINAL 062117.doc	No	Paper Only
Form and Instruction	n/a	Pre-Discussion Information Survey for Health Care Professionals	Attach 3_HCP PDIS FINAL 062117.doc	No	Paper Only
Form and Instruction	n/a	In-Depth Interview Guide for Health Care Professionals	Attach 4_HCP IDI Guide FINAL 062117.docx	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

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: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Test Item 1. Conversation Starters	1.Conversation Starters_FINAL 04.21.17.docx	06/21/2017
Test Item 2. Print Ad_Safe Play	2.AU PSA Print Ad_Safe Play.pdf	06/21/2017
Test Item 3. Print Ad_Status Update	3.AU PSA Print Ad_Status Update.pdf	06/21/2017
Test Item 4. Print Ad_The Right Tool	4.AU PSA Print Ad_The Right Tool.pdf	06/21/2017
Test Item 5. Campaign Stimulus_TV Ads	5.AU Campaign Stimulus_TV Ads.docx	06/21/2017
Test Item 6. Visual with slogan_A	6.Visual with slogan_A.png	06/21/2017
Test Item 7. Visual with slogan_B	7.Visual with slogan_B.png	06/21/2017
Test Item 8. Visual with slogan_C	8.Visual with slogan_C.png	06/21/2017
Test Item 9. Visual with slogan_D	9.Visual with slogan_D.jpg	06/21/2017
Test Item 10. Visual with slogan_E	10.Visual with slogan_E.jpg	06/21/2017
Project Description	Attach 1_AU R2 HCP Project Desc and Burden_062117.docx	06/22/2017
HMTS Expedited Review Form (AU R2/HCP)	HMTS Expedited Review Form - AU R2 Campaign - HCPs 062017.pdf	06/22/2017
Verbal Consent	Attach 5_Verbal Consent IDI-FG FINAL 062117.docx	06/22/2017
Observer Confidentiality Agreement	Attach 6_Observer Confidentiality_FINAL 062117.doc	06/22/2017

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