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Structural Assessments

IC 258913 under ICR 202407-0935-001 · OMB 0935-0265.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Structural Assessments
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Structural Assessment-Improving Antibiotic Use Cohort-Brick and Mortar Practices Attachment A Structural Assessment - Antibiotic Use Cohort_Brick and Mortar (updated).docx Yes Yes Fillable Fileable
Form and Instruction 2 Structural Assessment - Improving Antibiotic Use Cohort - Telemedicine-Only Organizations Attachment B Structural Assessment - Antibiotic Use Cohort_Telemedicine Only (updated).docx Yes Yes Fillable Fileable

Health Health Care Services

 

188 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 376 0 -24 0 0 400
Annual IC Time Burden (Hours) 75 0 -5 0 0 80
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.