Information Collection

Sepsis Educational Awareness Message/Materials Assessment - Consumers

IC 229832 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.