Assessment for the Get Ahead of Sepsis Consumer Campaign

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0572 Assessment for the Get Ahead of Sepsis Consumer Campaign Form and Instruction
0920-0572 GAOS Consumer Survey Pre-test HMTS Attachment D_GAOS Consumer Survey PRE-TEST HMTS.pdf Form and Instruction
0920-0572 GAOS Consumer Survey Post-test HMTS Attachment F_GAOS Consumer Survey POST-TEST HMTS.pdf Form and Instruction
Attachment A_GAOS Pilot Assessment Overview_Consumers.docx GAOS Overview Consumers IC Document
Attachment B_GAOS Consumer Recruitment Invitation final.docx Consumer Recruitment Invitation IC Document
Attachment C_GAOS Consumer Survey_1.24.20_FINAL PRETEST.docx Pretest Instrument Word version IC Document
Attachment E_GAOS Consumer Survey_1.24.20_FINAL POSTTEST.docx Posttest Instrument Word version IC Document
Attachment G_GAOS Consumer and HCP Exempt 12.20.19.pdf Human Subjects Determination IC Document
Attachment H_GAOS Consumer Materials for 2020 Assessment FINAL.pdf GAOS Consumer Materials for Assessment IC Document
HMTS Expedited Review Form - GAOS Consumer Assessment final.pdf HMTS Expedited Review Form GAOS IC Document

Information Collection (IC) Details

IC Title:	Assessment for the Get Ahead of Sepsis Consumer Campaign	Agency IC Tracking Number:	0920-0572-20HL

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 and Instruction	0920-0572	GAOS Consumer Survey Pre-test HMTS	Attachment D_GAOS Consumer Survey PRE-TEST HMTS.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	GAOS Consumer Survey Post-test HMTS	Attachment F_GAOS Consumer Survey POST-TEST HMTS.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 360	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	360	360
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GAOS Overview Consumers	Attachment A_GAOS Pilot Assessment Overview_Consumers.docx	02/26/2020
Consumer Recruitment Invitation	Attachment B_GAOS Consumer Recruitment Invitation final.docx	02/26/2020
Pretest Instrument Word version	Attachment C_GAOS Consumer Survey_1.24.20_FINAL PRETEST.docx	02/26/2020
Posttest Instrument Word version	Attachment E_GAOS Consumer Survey_1.24.20_FINAL POSTTEST.docx	02/26/2020
Human Subjects Determination	Attachment G_GAOS Consumer and HCP Exempt 12.20.19.pdf	02/26/2020
GAOS Consumer Materials for Assessment	Attachment H_GAOS Consumer Materials for 2020 Assessment FINAL.pdf	02/26/2020
HMTS Expedited Review Form GAOS	HMTS Expedited Review Form - GAOS Consumer Assessment final.pdf	02/26/2020

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