Dental Survey: Improving Outpatient Antibiotic Use through Implementation and Evaluation of Core Elements of Outpatient Antibiotic Stewardship

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-XXXX Dental Survey-Practices and Experiences with Antibotic Prescribing (Online version)	Form	New	Repair queued
Att. 9-IRB_Approval.pdf	Supplementary Document	Uploaded 2019-04-05	Repair queued
Published 60dy1818APX.pdf	Supplementary Document	Uploaded 2019-04-05	Repair queued
Att. 1 - Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2019-04-05	Repair queued
SupSta _Outpatient Abx.docx	Supporting Statement B	Uploaded 2019-04-05	Repair queued
Sup Sta_Outpatient Abx.docx	Supporting Statement A	Uploaded 2019-04-05	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
235612	Dental Survey - CDC Outpatient SHEPheRD (Paper version)	Other-WORD	New
235611	Dental Survey-Practices and Experiences with Antibotic Prescribing (Online version)	Form	New
235610	Inital Recruitment Email	Other-Email	New

ICR Details

OMB Control No:	ICR Reference No: 201904-0920-003
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-18APX
Title: Dental Survey: Improving Outpatient Antibiotic Use through Implementation and Evaluation of Core Elements of Outpatient Antibiotic Stewardship
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 08/01/2019
	Date Received in OIRA: 04/17/2019
Terms of Clearance: Withdrawn at agency request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		24 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of this study is to assess knowledge, attitudes, practices, and perceived provider level barriers to appropriate antibiotic prescribing in a representative sample of dental providers. Data will be used to provide suggestions for improving interventions that target appropriate antibiotic prescribing within the dental community.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 39757	08/10/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 11098	03/25/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Inital Recruitment Email
Dental Survey-Practices and Experiences with Antibotic Prescribing (Online version)	0920-XXXX	Dental Survey_CDC Outpatient SHEPheRD Practice and Experiences with Antibotic Prescribing
Dental Survey - CDC Outpatient SHEPheRD (Paper version)

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a NEW information collection request.

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Annual Cost to Federal Government: $4,943

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/17/2019

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