Assessment of Get Ahead of Sepsis Camplaign - 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⚠️ Notice: This information collection may be referencing outdated material.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 of Get Ahead of Sepsis Camplaign - Health Care Providers Form
GAOS Pretest - Health care providers Attachment D_GAOS HCP Survey_1.24.20_FINAL PRETEST.docx Form
GAOS - Posttest - Health care providers Attachment F_GAOS HCP Survey_1.24.20_FINAL POSTTEST.docx Form
Attachment A_GAOS Pilot Assessment Overview_HCPs.docx Assessment overview IC Document
Attachment B_GAOS HCP Incentive Justification.docx Incentive justification IC Document
Attachment C_GAOS HCP Recruitment Invitation.docx Recruitment invitation IC Document
Attachment H_GAOS Consumer and HCP Exempt 12.20.19.pdf Research determination IC Document
Attachment I_GAOS HCP Materials for 2020 Assessment FINAL.pdf Assessment materials IC Document
Attachment E_GAOS HCP Survey PRE-TEST HMTS.pdf Pretest - screenshots IC Document
Attachment G_GAOS HCP Survey POST-TEST HMTS.pdf Posttest- screenshots IC Document
HMTS Expedited Review Form - GAOS HCP Assessment.pdf genIC Review form IC Document

Information Collection (IC) Details

IC Title:	Assessment of Get Ahead of Sepsis Camplaign - Health Care Providers	Agency IC Tracking Number:	0920-0572-20HM

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	GAOS Pretest - Health care providers	Attachment D_GAOS HCP Survey_1.24.20_FINAL PRETEST.docx		Yes	Yes	Fillable Fileable
Form	none	GAOS - Posttest - Health care providers	Attachment F_GAOS HCP Survey_1.24.20_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: 450	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	450	450
Annual IC Time Burden (Hours)	113	113
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Assessment overview	Attachment A_GAOS Pilot Assessment Overview_HCPs.docx	02/10/2020
Incentive justification	Attachment B_GAOS HCP Incentive Justification.docx	02/10/2020
Recruitment invitation	Attachment C_GAOS HCP Recruitment Invitation.docx	02/10/2020
Research determination	Attachment H_GAOS Consumer and HCP Exempt 12.20.19.pdf	02/10/2020
Assessment materials	Attachment I_GAOS HCP Materials for 2020 Assessment FINAL.pdf	02/10/2020
Pretest - screenshots	Attachment E_GAOS HCP Survey PRE-TEST HMTS.pdf	02/12/2020
Posttest- screenshots	Attachment G_GAOS HCP Survey POST-TEST HMTS.pdf	02/12/2020
genIC Review form	HMTS Expedited Review Form - GAOS HCP Assessment.pdf	02/12/2020

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