Sepsis Educational Awareness Message/Materials Assessment - Consumers

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⚠️ Notice: This information collection may be referencing outdated material.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 Educational Awareness Message/Materials Assessment - Consumers Form
Sepsis Assessment - Consumers 3 Sepsis Assessment R3 SEMS Screenshots Consumer_012518.pdf Form
2 Sepsis Assessment R3 HMTS Expedited Review Form CONSUMER ONLY 12 28 2....pdf Expedited Review Form IC Document
1 Sepsis Assessment R3 Project Description CONSUMER ONLY 12 28 2017_FIN....docx Project description IC Document
4 Sepsis Assessment R3 Incentive Justification - Consumers.docx Justification for incentives IC Document
5 IRB Expedited Review of sepsis educational materials - Consumers.docx IRB review IC Document
6 Sepsis R3 Consumer Materials Merged 2018 1 25.pdf Sepsis Materials IC Document

Information Collection (IC) Details

IC Title:	Sepsis Educational Awareness Message/Materials Assessment - Consumers	Agency IC Tracking Number:	0920-0572-18LA

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	none	Sepsis Assessment - Consumers	3 Sepsis Assessment R3 SEMS Screenshots Consumer_012518.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,594	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	1,594	1,594
Annual IC Time Burden (Hours)	598	598
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Expedited Review Form	2 Sepsis Assessment R3 HMTS Expedited Review Form CONSUMER ONLY 12 28 2....pdf	01/24/2018
Project description	1 Sepsis Assessment R3 Project Description CONSUMER ONLY 12 28 2017_FIN....docx	01/24/2018
Justification for incentives	4 Sepsis Assessment R3 Incentive Justification - Consumers.docx	01/24/2018
IRB review	5 IRB Expedited Review of sepsis educational materials - Consumers.docx	01/24/2018
Sepsis Materials	6 Sepsis R3 Consumer Materials Merged 2018 1 25.pdf	01/25/2018

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