Information Collection

Structural Assessments

IC 258913 under ICR 202303-0935-001 · OMB 0935-0265.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0265 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Structural Assessments	Form and Instruction
1 Attachment A: Structural Assessment_Cancer Diagnostic Pr Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx	Form and Instruction
1 Attachment A: Structural Assessment_Cancer Diagnostic Pr Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx	Form and Instruction
2 Attachment B: Structural Assessment_Antibiotic Stewardsh Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx	Form and Instruction
2 Attachment B: Structural Assessment_Antibiotic Stewardsh Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx	Form and Instruction
Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx Structural Assessment_Cancer Diagnostic Process Cohort	IC Document
Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx Structural Assessment_Cancer Diagnostic Process Cohort	IC Document
Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx Structural Assessment_Antibiotic Stewardship Cohort	IC Document
Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx Structural Assessment_Antibiotic Stewardship Cohort	IC Document

IC Title:

Structural Assessments

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	1	Attachment A: Structural Assessment_Cancer Diagnostic Process Cohort	Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Attachment B: Structural Assessment_Antibiotic Stewardship Cohort	Att B_Structural Assessment_Antibiotic Stewardship Cohort.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: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	400	400
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Structural Assessment_Cancer Diagnostic Process Cohort	Att A_Structural Assessment_Cancer Diagnostic Process Cohort 1.26.2023.docx	03/06/2023
Structural Assessment_Antibiotic Stewardship Cohort	Att B_Structural Assessment_Antibiotic Stewardship Cohort.docx	03/06/2023

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