Assessment for the Be Antibiotics Aware Campaign - Health Care Providers

CDC and ATSDR Health Message Testing System

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	BAA Pretest - Heath care providers	Attachment D_BAA HCP Survey_2020-01-23 FINAL PRETEST.docx		Yes	Yes	Fillable Fileable
Form	none	BAA Posttest - Health care providers	Attachment F_BAA HCP Survey_2020-01-23 FINAL POSTTEST.docx		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 %

	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

Title	Document	Date Uploaded
Assessment overview	Attachment A_BAA Pilot Assessment Overview_HCPs.docx	02/10/2020
Incentive justification	Attachment B_BAA HCP Incentive Justification.docx	02/10/2020
Recruitment invitation	Attachment C_BAA HCP Recruitment Invitation.docx	02/10/2020
Research determination	Attachment H_BAA HCP Exempt 12.17.19.pdf	02/10/2020
Materials for assessment	Attachment I_Final AU HCP Materials for Assessment.pdf	02/10/2020
Pretest screenshots	Attachment E_BAA HCP Survey PRETEST - Screenshots.pdf	02/12/2020
Posttest screenshots	Attachment G_BAA HCP Survey POSTTEST - Screenshots.pdf	02/12/2020
genIC Review form	HMTS Expedited Review Form - BAA HCP Assessment.pdf	02/12/2020

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