Information Collection

Assessment for the Be Antibiotics Aware (BAA) Consumer Campaign

IC 239863 under ICR 201806-0920-001 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0572 Assessment for the Be Antibiotics Aware (BAA) Consumer Campaign	Form and Instruction
0920-0572 BAACS Survey FINAL PRETEST Attachment C_BAA Consumer Survey_2020-01-22 FINAL PRETEST.docx	Form and Instruction
0920-0572 BAA Consumer Survey_FINAL POSTTEST Attachment E_BAA Consumer Survey_2020-01-22 FINAL POSTTEST.docx	Form and Instruction
Attachment A_BAA Pilot Assessment Overview_Consumers.docx Att A_BAA Polot AAssessment Overview	IC Document
Attachment B_BAA Consumer Recruitment Invitation.docx Att B_BAA Consumer Recruitment Invitation	IC Document
Attachment D_BAA Consumer Survey PRETEST - Screenshots.pdf Att D_BAA Consumer Survey PRESEST_Screenshots	IC Document
Attachment F_BAA Consumer Survey POSTTEST - Screenshots.pdf Att F_BAA Consumer Survey POSTTEST_Screenshots	IC Document
Attachment G_BAA Consumers Exempt 12.10.19.pdf AttG_BAA Consumers Exempt	IC Document
HMTS Expedited Review Form - BAA Consumer Assessment.pdf Att H_AU Consumer Materials for Asessment Combined_FINAL	IC Document

IC Title:

Assessment for the Be Antibiotics Aware (BAA) Consumer Campaign

Agency IC Tracking Number:

0920-0572-20HI

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 and Instruction	0920-0572	BAACS Survey FINAL PRETEST	Attachment C_BAA Consumer Survey_2020-01-22 FINAL PRETEST.docx		Yes	Yes	Fillable Printable
Form and Instruction	0920-0572	BAA Consumer Survey_FINAL POSTTEST	Attachment E_BAA Consumer Survey_2020-01-22 FINAL POSTTEST.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 180

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	180	180
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att A_BAA Polot AAssessment Overview	Attachment A_BAA Pilot Assessment Overview_Consumers.docx	02/13/2020
Att B_BAA Consumer Recruitment Invitation	Attachment B_BAA Consumer Recruitment Invitation.docx	02/13/2020
Att D_BAA Consumer Survey PRESEST_Screenshots	Attachment D_BAA Consumer Survey PRETEST - Screenshots.pdf	02/13/2020
Att F_BAA Consumer Survey POSTTEST_Screenshots	Attachment F_BAA Consumer Survey POSTTEST - Screenshots.pdf	02/13/2020
AttG_BAA Consumers Exempt	Attachment G_BAA Consumers Exempt 12.10.19.pdf	02/13/2020
Att H_AU Consumer Materials for Asessment Combined_FINAL	HMTS Expedited Review Form - BAA Consumer Assessment.pdf	02/13/2020

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