Att 4_TCEO Proposal

Attachment 4

Information Collection Instrument,

Training and Continuing Education Online Proposal

TCEO Proposal	2015

Table of Contents

1. Introduction 2

2. Login Page 2

3. Activity Filter/Selection Page 2

4. Application Status Page 2

5. Practice Gap Page 2

6. Target Audience Page 2

7. Facility Page 2

8. Promo/Eval Page 2

9. Timeline Page 2

10. Summary Page 2

11. Objectives Page 2

12. Planning Tool Page 2

13. Credit Provider Page 2

14. Budget Page 2

15. Pilot Test List Page 2

16. Pilot Test Summary Page 2

17. Activity Testing Page 2

18. Activity Testing Group Page 2

19. Activity Testing Question Page 2

20. Activity Testing Answers Page 2

21. Supporting Documents Page 2

22. Activity Notes Page 2

23. Non-CDC User Page 2

24. Biography Page 2

25. Biography Degree Page 2

26. Disclosure Page 2

27. Organization Page 2

1. Introduction

The purpose of this document is to list the data elements collected online through the Training and Continuing Education Proposal module. The TCEO Proposal module is a mechanism for course developers and CE consultants of the Centers for Disease Control and Prevention (CDC) to request and submit their course application processes.

The major pages of the TCEO Proposal are detailed in this document. The main screenshots of the TCEO Proposal pages, sections, or subsections are from a live course with a single session and all credit types selected. Following the screenshots in each section is a table that shows the status of the collection of data elements. Figure 1 illustrates the Welcome page, which details brief instructions that the system respondents need to be aware of prior to starting a course application.

Figure 1 – Welcome page

2. Login Page

Participants enter the TCEO Proposal module by entering their email address and password on the Login page (Figure 2). Users accessing the TCEO Proposal module for the first time must register using the “Register now” link displayed on this page.

Figure 2a –Login page

Users also have access to the legal privacy act information and advisement, as well as the public burden information statements by clicking the applicable buttons located near the bottom of the Login page.

Figure 2b – Login page with legal statements

Table 1 – Privacy Act and Public Burden Statements

Privacy Act Information and Advisement

Public Burden Information

The Privacy Act applies to this information collection. The requested information is used to process your request for educational activities to receive continuing education accreditation. CDC will treat data/information in a secure manner and will not disclose, unless otherwise compelled by law or upon your written request. Continuing education accreditation can only be conferred when all requested information is submitted.

CDC estimates the average public reporting burden for this collection of information as 5 hours per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments and regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0017).

Table 2 – Login Page Data Elements

Column Label	Display property	Figure
Email	Text	2
Password	Text	2
What would you like to do first?		2

3. Activity Filter/Selection Page

Figure 3 – Activity Filter/ Selection Page

Table 3- Activity Filter/ Selection Page Data Elements

Column Label	Display property	Figure
Start Date	Numeric	3
Activity Number	Numeric	3
Title	Text	3
Role	Role Drop Down	3
User Name	Auto populate / Drop Down	3
Status	Status Drop Down	3
Credit Type	Multi Select- Credit Type	3
Activity Sub-Type	Multi Select – Activity Subtype	3

4. Application Status Page

Figure 4a – Application Status Page: Activity

Figure 4b – Application Status Page: Activity Version

Figure 4c – Application Status Page: Activity Instance

Table 4 – Application Status Page Data Elements

Column Label	Display property	Figure
Activity Number	Numeric	4a
Activity Title	Text	4a
Activity Type	Drop Down – Activity Type	4a
Contact Source	Drop Down – Contact Source	4a
Goal Statement	Text	4a
Activity Objectives	Text	4a
Activity Description	Text	4a
Directly Sponsored	Yes/No	4a
Activity Status	Drop Down – Activity Status	4a
Version Name	AutoPopulated	4b
Accreditation Start Date	Date/Time	4b
Accreditation End Date	Date/Time	4b
Credit Types	Multi-Select- Credit Types	4b
Activity Sub-Type	Drop Down – Activity SubType	4c
Activity Date	Date/Time	4c
UAN Number	Text	4c
Location	Text	4c
Address 1	Text	4c
Address 2	Text	4c
Address 3	Text	4c
City	Text	4c
State	Text or Drop Down State	4c
Postal Code	Text	4c
Country	Drop Down - Country	4c

5. Practice Gap Page

Figure 5 – Practice Gap

Figure 5a – Gap Description

Figure 5b – Performance Impact & Supporting Documentation

Table 5 – Practice Gap Page Data Elements

Column Label	Display property	Figure
Practice Gap Address	Multi Select – Practice Gap	5
Continuing Pharmacy Education	Multi Select – Continuing Pharmacy Education	5
Identify Education Needs	Multi Select - Identify Education Needs	5
IOM Competencies	Multi Select – IOM Competencies	5
Competencies	Multi Select - Competencies	5
Gap Description	Text Box	5a
Performance Impact	Text Box	5b
Supporting Documents	Document Upload	5b

6. Target Audience Page

Figure 6 – Target Audience Page

Table 6 – Target Audience Page Data Elements

Column Label	Display property	Figure
Target Audience	Multi Select - Target Audience	6
Audience Identification Method	Multi Select – Audience Identification Method	6
Prerequisite Skills and Knowledge	Text Box	6

7. Facility Page

Figure 7 – Facility Page

Table 7 – Facility Page Data Elements

Column Label	Display property	Figure
Facility in which the education takes place	Multi Select Facility in which the education takes place	7
Appropriateness of Physical facilitates	Multi Select –Appropriateness of physical facilities	7
Prerequisite Skills and Knowledge	Text Box	7

8. Promo/Eval Page

Figure 8 – Promo / Eval Page

Table 8 - Promo / Eval Page Data Elements

Column Label	Display property	Figure
Promotion Methods	Multi Select – Promotion Methods	8
Evaluation Categories	Multi Select –Evaluation Categories	8
Learner Feedback Strategies	Multi Select – Learner Feedback Strategies	8
Participant Evaluation Methods	Drop Down-Participant Evaluation Methods	8

9. Timeline Page

Figure 9 – Timeline Page

Table 9 – Timeline Page Data Elements

Column Label	Display property	Figure
Version	Read only	9
Date Issued	Read only	9
Date Accepted	Read only	9
Reason	Text Box	9
Planning Tool	Date Field	9
Draft CE Proposal	Date Field	9
Final CE Proposal	Date Field	9
CME Review	Date Field	9
Contact TCEO Coordinator	Date Field	9

10. Summary Page

Figure 10 – Summary Page

Table 10 – Summary Page Data Elements

Column Label	Display property	Figure
Section	Read only	10
Updated on	Read only	10
Updated by	Read only	10

11. Objectives Page

Figure 11 – Objectives Page

Table 11 – Objectives Page Data Elements

Column Label	Display property	Figure
Description	Text Field	11
List Order	Numeric	11

12. Planning Tool Page

Figure 12 – Planning Tool Page

Table 12 – Planning Tool Page Data Elements

Column Label	Display property	Figure
Session Title	Text Field	12
Session Description	Text Field	12
Segment Title	Text	12
Objectives	Multi Select (list is generated from Objective screen)	12
Content Addressing Objective	Text Field	12
Presenter/Content Expert	Drop Down – List is generated from Personnel screen	12
Duration Start	Time and Date	12
Duration End	Time and Date	12
Duration	Numeric	12
Location	Text	12
Instructional Strategies	Multi Select –Instructional strategies	12
CHES	Multi Select – CHES Competencies	12

13. Credit Provider Page

Figure 13 – Credit Provider Page

Table 13 – Credit Provider Page Data Elements

Column Label	Display property	Figure
Joint Provider	Drop Down – List of Organizations that have been added TCEO application	13
Co-Provider	Drop Down – List of Organizations that have been added TCEO application	13

14. Budget Page

Figure 14 – Budget Page

Table 14 – Budget Page Data Elements

Column Label	Display property	Figure
Funding Source	Drop Down – List of Organizations that have been added TCEO application	14
Funding Recipient	Drop Down – List of Organizations that have been added TCEO application	14
In Kind	Drop Down – Yes/No	14
Funding User Description	Text Box	14
Funding Type	Drop Down –Funding Types	14
Grant Recipient	Drop Down – Yes / No	14
Funding User	Drop Down – Funding Use	14
New Organization	Hyperlink	14
Upload New Item	Button	14
File	Browse and Select File	14
Description	Text Box	14

15. Pilot Test List Page

Figure 15 – Pilot Test List Page

Table 15 – Pilot Test List Page Data Elements

Column Label	Display property	Figure
Include	Checkbox	15
Which Pilot Tester	Drop Down – List of Pilot Testers that have been added TCEO application	15
Pilot Test Date	Date Field	15
Which Credit for this activity	Drop Down – Available Credit Types	15
Minutes to complete	Numeric	15
Profession	Multi Select – Profession specific to selected Credit Type	15
Instructions Effective	Drop Down – Yes/No	15
Objectives – Effective	Drop Down – Yes/No	15
Course Content – Effective	Drop Down – Yes/No	15
Tables/Figures/Graphics – Effective	Drop Down – Yes/No	15
Quiz/Exercise Questions – Effective	Drop Down – Yes/No	15
Text/Exam	Drop Down – Yes/No	15
Instructions – Reason	Text Box	15
Objectives – Reason	Text Box	15
Course Content – Reason	Text Box	15
Tables/Figures/Graphics – Reason	Text Box	15
Quiz/Exercise Questions – Reason	Text Box	15
Text/Exam – Reason	Text Box	15
Willing to participate in future pilot testing	Drop Down – Yes/No	15
Comments	Text Box	15

16. Pilot Test Summary Page

Figure 16 – Pilot Test Summary Page

Table 16 – Pilot Test Summary Page Data Elements

Column Label	Display property	Figure
Duration Method	Drop Down List – Duration Method	16
Relevance of Activity	Text Box	16
Feedback Documentation	Text Box	16
Results Statement	Text Box	16
Other Details	Text Box	16
Feedback Incorporation	Text Box	16

17. Activity Testing Page

Figure 17 – Activity Testing Page

Table 17 – Activity Testing Page Data Elements

Column Label	Display property	Figure
Type	Drop Down List – Test Type	17
Scope	Drop Down List – Scope	17
Learning Session	Drop Down List – Activity’s Sessions	17
Content Segment	Drop Down List – Activity’s Segments	17
Name	Text Box	17
Activity Version	Drop Down List – Activity’s Versions	17
Passing Score	Numeric Field for each selected Credit Type	17

18. Activity Testing Group Page

Figure 18 – Activity Testing Group Page

Table 18 – Activity Testing Group Page Data Elements

Column Label	Display property	Figure
List Order	Numeric	18
Header	Text Box	18
Note	Text Box	18
Note Position	Drop Down – Above/Below	18
Select Graphic	Button / Browse	18
Graphic Position	Drop Down List – Above / Below	18

19. Activity Testing Question Page

Figure 19 – Activity Testing Question Page

Table 19 – Activity Testing Question Page Data Elements

Column Label	Display property	Figure
List Order	Numeric	19
Question Type	Drop Down – Question Type	19
Question Display	Drop Down- Vertical / Horizontal / Drop Down List	19
Random Answers	Checkbox	19
Question Repeats	Drop Down List –Per Nothing /Per Objective / Per Presenter	19
Answer Required	Checkbox	19
Question Text	Text Box	19
Note	Text Box	19
Note Position	Drop Down – Above / Below	19
Graphic Select	Button / Browse	19
Graphic Position	Drop Down – Above / Below	19

20. Activity Testing Answers Page

Figure 20 – Activity Testing Answers Page

Table 20 – Activity Testing Answers Page Data Elements

Column Label	Display property	Figure
List Order	Numeric	20
Correct	Drop Down –Yes/No	20
Answer Text	Text Box	20
Feedback Text	Text Box	20

21. Supporting Documents Page

Figure 21 – Supporting Documents Page

Table 21 – Supporting Documents Page Data Elements

Column Label	Display property	Figure
Select File	Button / Select	21
Upload Type	Drop Down List – Document Type	21
Description	Text	21

22. Activity Notes Page

Figure 22 – Activity Notes Page

Table 22 – Activity Notes Page Data Elements

Column Label	Display property	Figure
Notes	Text Box	22

23. Non-CDC User Page

Figure 23 – Non-CDC User Page

Table 23 – Non-CDC User Page Data Elements

Column Label	Display property	Figure
Prefix	Text Box	23
Last Name	Text Box	23
First Name	Text Box	23
Middle Name	Text Box	23
Suffix	Text Box	23
Login id / email Address	Text Box	23
Primary Work Phone	Radio Button	23
Work Phone Country	Drop Down - Country	23
Work Phone – Phone Number	Numeric	23
Work Phone – Phone Number Extension	Numeric	23
Cell Phone – Primary	Radio Button	23
Cell Phone – Country	Drop Down - Country	23
Add as Role	Drop Down – Activity Role / System Role	23
Role	Drop Down – Role	23

24. Biography Page

Figure 24 – Biography Page

Table 24 – Biography Page Data Elements

Column Label	Display property	Figure
Job Title	Text Box	24
Relevant Experience	Text Box	24
Date Submitted	Date field	24
Resume Select	Button / Browse	24
Approved/Rejected	Drop Down – Approved / Rejected	24
Reason	Text Box	24

25. Biography Degree Page

Figure 25 – Biography Degree Page

Table 25 – Biography Degree Page Data Elements

Column Label	Display property	Figure
Degree	Drop Down - Degree	25
Major	Text Box	25
School	Text Box	25
City	Button / Browse	25
Country	Drop Down – Country	25
State	Drop Down - State	25
Graduation Year	Date Field	25

26. Disclosure Page

Figure 26 – Disclosure Page

Table 26 – Disclosure Page Data Elements

Column Label	Display property	Figure
Disclosed on	Date Field	26
Financial Relationship	Drop Down – Yes/No	26
Mechanism to Resolve	Drop Down – Discussion / Review /Planning Committee Review	26
Unlabeled Use	Drop Down – Yes/ No	26
Disclosure	Button / Browse	26
Disclosure Summary	Text Box	26
Approved/Rejected	Drop Down – Approved / Rejected	26
Reason	Text Box	26

27. Organization Page

Figure 27 – Organization Page

Table 27 – Organization Page Data Elements

Column Label	Display property	Figure
Name	Text Box	27
Parent Organization	Drop Down – Organizations previously entered	27
Organization Type	Drop Down – Organization Types	27
Approved	Drop Down – Yes/ No	27
Reason	Text Box	27