Att 4_TCEO Proposal

Application for Training

Att. 4- TCEO Proposal Module_01-19-2016

Att 4_TCEO Proposal

OMB: 0920-0017

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Attachment 4

Information Collection Instrument,

Training and Continuing Education Online Proposal













TCEO Proposal

2015
















  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


  1. 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


  1. 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


  1. 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



  1. 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


  1. 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


  1. 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


  1. 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

  1. 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

  1. 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


  1. 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


  1. 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


  1. 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









  1. 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

















  1. 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


  1. 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














  1. 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


  1. 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


  1. 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



  1. 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


  1. 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







  1. Activity Notes Page


Figure 22 – Activity Notes Page


Table 22 – Activity Notes Page Data Elements

Column Label

Display property

Figure

Notes

Text Box

22


  1. 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


  1. 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


  1. 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













  1. 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











  1. 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


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