OMB control number

Standardizing Antibiotic Use in Long-term Care Setting

OMB 0935-0177 · HHS/AHRQ.

OMB 0935-0177

Latest forms, documents, and information collections
Document	Type
Form Form #5 Post-Implementation Semi-Structured Interview Protocol	Form and Instruction
Form Form #4 Post-Training Semi-Structured interview Protocol	Form and Instruction
Form Form #3 Pre-Implementation Semi-Structured Interview Protocol	Form and Instruction
Form Form #2 Staff Training Guide	Form and Instruction
Form Form #1 Loeb Criteria Communication and Order Form	Form and Instruction
Waiver of Consent-TAMU.pdf	Supplementary Document
Waiver of Consent-AIR.pdf	Supplementary Document
IRB Approval-TAMU.pdf	Supplementary Document
IRB Approval-AIR.pdf	Supplementary Document
HIPPA-WAIVER-SAUL-TAMU.pdf	Supplementary Document
Supporting Statement Part B -- Standardizing Antibiotic Use in LTC Settings 4-18-2011.doc	Supporting Statement B
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document
Attachment J-Consent Form for Interviews.doc	Supplementary Document
Attachment I-Information Sheet.doc	Supplementary Document
Attachment H -- Federal Register Notice.pdf	Supplementary Document
Attachment C-Medical Record Data Abstraction Form.doc	Supplementary Document
Supporting Statement Part A -- Standardizing Antibiotic Use in LTC Settings 4-18-2011.doc	Supporting Statement A
Post-implementation semi-structured interview	Form and Instruction
Post training semi-structured interview	Form and Instruction
Pre-implementation semi-structured interview	Form and Instruction
Staff training	Form and Instruction
Loeb Criteria COF	Form and Instruction

Historical document collections
Reference	Filing	Received	Concluded	Action
201102-0935-001	New collection (Request for a new OMB Control Number)	2011-02-15		Approved with change