Sepsis Educational Awareness Message/Materials Assessment - HCP

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.