Information Collection

Core Elements of Antimicrobial Stewardship in Nursing Homes

IC 231812 under ICR 201610-0920-009 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Core Elements of Antimicrobial Stewardship in Nursing Homes	Form
Prescriber Assessment CDC - Combined Survey_OMB_updated.docx	Form
Att B - Email invitation.docx Email invitation	IC Document
Att C - Consent Form.docx Consent	IC Document
Att D - Non-research determination.pdf Non-research determination	IC Document
GenIC Request.docx genIC Request for Approval	IC Document
Supporting Statement B_ Nursing Home Antibiotic Stewardship 17MAY2018.docx Supporting Statement B	IC Document
Supporting Statement A_Nursing Home Antibiotic Stewardship.docx Supporting Statement A	IC Document

IC Title:

Core Elements of Antimicrobial Stewardship in Nursing Homes

Agency IC Tracking Number:

0920-1154-18ADR

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	Prescriber Assessment	CDC - Combined Survey_OMB_updated.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 992

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	992	992
Annual IC Time Burden (Hours)	496	496
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email invitation	Att B - Email invitation.docx	06/14/2018
Consent	Att C - Consent Form.docx	06/14/2018
Non-research determination	Att D - Non-research determination.pdf	06/14/2018
genIC Request for Approval	GenIC Request.docx	06/14/2018
Supporting Statement B	Supporting Statement B_ Nursing Home Antibiotic Stewardship 17MAY2018.docx	06/14/2018
Supporting Statement A	Supporting Statement A_Nursing Home Antibiotic Stewardship.docx	06/14/2018

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