OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)

IC 237853 under ICR 201806-0920-001 · OMB 0920-0572.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs) 0920-19BSC
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Screening Form for Dentists SCREENER - Dentist_CLEARED_2019-10-01.docx Yes Yes Fillable Fileable
Form and Instruction n/a Screening Form for Hospitalists SCREENER - Hospitalist_CLEARED_2019-10-01.docx Yes Yes Fillable Fileable
Form and Instruction n/a Screening Form for Nurses in Nursing Homes SCREENER - Nurse_CLEARED_2019-10-01.docx Yes Yes Fillable Fileable
Form and Instruction n/a Screening Form for Community Pharmacists SCREENER - Pharmacist_CLEARED_2019-10-01.docx Yes Yes Fillable Fileable
Form and Instruction n/a Screening Form for Advanced Practice Providers and Physicians in Nursing Homes SCREENER - Physician_CLEARED_2019-10-01.docx Yes Yes Fillable Fileable
Form and Instruction n/a Interviewer Guide for Dentists GUIDE - Dentist_CLEARED_2019-10-02.docx Yes Yes Fillable Fileable
Form and Instruction n/a Interviewer Guide for Hospitalists GUIDE - Hospitalist_CLEARED_2019-10-02.docx Yes Yes Fillable Fileable
Form and Instruction n/a Interviewer Guide for Nurses in Nursing Homes GUIDE - Nurse_CLEARED_2019-10-02.docx Yes Yes Fillable Fileable
Form and Instruction n/a Interviewer Guide for Community Pharmacists GUIDE - Pharmacist_CLEARED_2019-10-02.docx Yes Yes Fillable Fileable
Form and Instruction n/a Interviewer Guide for Advanced Practice Providers and Physicians in Nursing Homes GUIDE - Physician_CLEARED_2019-10-02.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

225 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 225 0 225 0 0 0
Annual IC Time Burden (Hours) 64 0 64 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HMTS Project Template HMTS Expedited Review Form_AU HCPs_2019-09-26.pdf 10/02/2019
HMTS Template Attachment A - Study Population HMTS Expedited Review Form_Attachment A_Study population (HCPs).docx 10/02/2019
HMTS Template Attachment B - Incentives HMTS Expedited Review Form_Attachment B_Incentives (HCPs).docx 10/02/2019
IRB Exemption Determination IRB Exempt Approval Documents 7-15-19.pdf 10/02/2019
Testing Item for Dentists (7 ways) MATERIALS - Dentists - 7 Ways Dentists Can BAA.pdf 10/02/2019
Testing Item for Dentists (Checklist) MATERIALS - Dentists - Checklist for Abx Rx.pdf 10/02/2019
Testing Item for Dentists (Abx) MATERIALS - Dentists - Do You Need Abx From Your Dentist.pdf 10/02/2019
Testing Item for Hospitalists (5 Ways) MATERIALS - Hospitalists - 5 Ways Hospitalists Can BAA.pdf 10/02/2019
Testing Item for Hospitalists (Flowsheet) MATERIALS - Hospitalists - Abx Time Out at Discharge Flowsheet.pdf 10/02/2019
Testing Item for Hospitalists (Poster) MATERIALS - Hospitalists - Avoid Treatment of ASB Poster.pdf 10/02/2019
Testing Item for Nurses (Avoid Treatment) MATERIALS - Nurses - Avoid Treatment of ASB.pdf 10/02/2019
Testing Item for Nurses (Do you Need) MATERIALS - Nurses - Do You Need Antibiotics.pdf 10/02/2019
Testing item for Nurses (Chart) MATERIALS - Nurses - What's Got You Sick Chart.pdf 10/02/2019
Testing Item for Pharmacists (Cold and Cough) MATERIALS - Pharmacists - Relief for Colds and Cough.pdf 10/02/2019
Testing Item for Pharmacists (Taking your Abx) MATERIALS - Pharmacists - Taking Your Abx.pdf 10/02/2019
Testing Item for Pharmacists (Penicillin Allergy) MATERIALS - Pharmacists - Verify Penicillin Allergy.pdf 10/02/2019
Testing Item for APP and Physicians (5 Ways) MATERIALS - Physicians - 5 Ways NH HCPs Can BAA.pdf 10/02/2019
Testing Item for APP and Physicians (Do you Need) MATERIALS - Physicians - Do You Need Antibiotics.pdf 10/02/2019
Testing Item for APP and Physicians (Communication) MATERIALS - Physicians - Improve Comm Poster.pdf 10/02/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.