Information Collection

Sepsis Educational Awareness Message/Materials Assessment - HCP

IC 229935 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⚠️ Notice: This information collection may be referencing outdated material.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 - HCP	Form
Sepsis Educational Awareness Assessment 3 Sepsis Assessment R3 SEMS Screenshots HCP_012518.pdf	Form
2 Sepsis Assessment R3 HMTS Expedited Review Form HCP ONLY 1 31 2018_FI....pdf Expedited Review Form	IC Document
1 Sepsis Assessment R3 Project Description HCP ONLY 1 31 2018_FINAL.DOCX Project Description	IC Document
4 Sepsis Assessment R3 Incentive Justification 1 31 2018_HCP_FINAL.DOCX Incentive Justification	IC Document
5 IRB Expedited Review of sepsis educational materials - HCPs.docx IRB Review	IC Document
6 Sepsis R3 HCP Materials Merged 2018 1 25.pdf Sepsis Messages/Materials	IC Document

IC Title:

Sepsis Educational Awareness Message/Materials Assessment - HCP

Agency IC Tracking Number:

0920-0572-18KZ

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 Educational Awareness Assessment	3 Sepsis Assessment R3 SEMS Screenshots HCP_012518.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 786

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	786	786
Annual IC Time Burden (Hours)	295	295
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 HCP ONLY 1 31 2018_FI....pdf	02/01/2018
Project Description	1 Sepsis Assessment R3 Project Description HCP ONLY 1 31 2018_FINAL.DOCX	02/01/2018
Incentive Justification	4 Sepsis Assessment R3 Incentive Justification 1 31 2018_HCP_FINAL.DOCX	02/01/2018
IRB Review	5 IRB Expedited Review of sepsis educational materials - HCPs.docx	02/01/2018
Sepsis Messages/Materials	6 Sepsis R3 HCP Materials Merged 2018 1 25.pdf	02/01/2018

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