Information Collection

Assessment for the Be Antibiotics Aware Campaign - Health Care Providers

IC 239891 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⚠️ Notice: This information collection may be referencing outdated material.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
BAA Pretest - Heath care providers Assessment for the Be Antibiotics Aware Campaign - Health Care Providers	Form
BAA Posttest - Health care providers Assessment for the Be Antibiotics Aware Campaign - Health Care Providers	Form
BAA Pretest - Heath care providers Attachment D_BAA HCP Survey_2020-01-23 FINAL PRETEST.docx	Form
BAA Posttest - Health care providers Attachment F_BAA HCP Survey_2020-01-23 FINAL POSTTEST.docx	Form
Attachment A_BAA Pilot Assessment Overview_HCPs.docx Assessment overview	IC Document
Attachment B_BAA HCP Incentive Justification.docx Incentive justification	IC Document
Attachment C_BAA HCP Recruitment Invitation.docx Recruitment invitation	IC Document
Attachment H_BAA HCP Exempt 12.17.19.pdf Research determination	IC Document
Attachment I_Final AU HCP Materials for Assessment.pdf Materials for assessment	IC Document
Attachment E_BAA HCP Survey PRETEST - Screenshots.pdf Pretest screenshots	IC Document
Attachment G_BAA HCP Survey POSTTEST - Screenshots.pdf Posttest screenshots	IC Document
HMTS Expedited Review Form - BAA HCP Assessment.pdf genIC Review form	IC Document

IC Title:

Assessment for the Be Antibiotics Aware Campaign - Health Care Providers

Agency IC Tracking Number:

0920-0572-20HJ

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				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 270

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	270	270
Annual IC Time Burden (Hours)	68	68
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].