Information Collection

Antibiotic Prescription Data Template_Antibiotic Use Cohort

IC 258926 under ICR 202407-0935-001 · OMB 0935-0265.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment G Antibiotic Prescription Data Template- Antibiotic Use Cohort (updated).xlsx	Other-database
Attachment G Antibiotic Prescription Data Template- Antibiotic Use Cohort (updated).xlsx	Other-database
Att L_Instructions for Anitbiotic Prescription Data Template_Antibiotic Stewardship Cohort.docx Instructions for Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort	IC Document
Att L_Instructions for Anitbiotic Prescription Data Template_Antibiotic Stewardship Cohort.docx Instructions for Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-database			Attachment G Antibiotic Prescription Data Template- Antibiotic Use Cohort (updated).xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225

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	Previously Approved
Annual Number of Responses for this IC	4,050	1,350	2,700
Annual IC Time Burden (Hours)	4,050	1,350	2,700
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions for Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort	Att L_Instructions for Anitbiotic Prescription Data Template_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.