Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Antibiotic Prescription Data Template_Antibiotic Use Cohort Modified 4050 4050 0 Other-database
Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort Removed 0 0 0 Form and Instruction 10 Attachment J: Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort
Diagnostic Safety Supplement Removed 0 0 0 Form and Instruction 5 Attachment E: Diagnostic Safety Supplement
Participant Experience Survey Modified 188 63 0 Form and Instruction 4 Participant Experience Survey - Improving Antibiotic Use Cohort_Brick-and-Mortar Practices
Form and Instruction 5 Participant Experience Survey - Improving Antibiotic Use Cohort_Telemedicine-Only Organizations
Participant Experience Survey_Cancer Diagnostic Process Cohort Removed 0 0 0 Form and Instruction 6 Attachment F: Participant Experience Survey_Cancer Diagnostic Process Cohort
Semi-Structured Qualitative Interviews (telemedicine-only and brick-and-mortar) Modified 18 18 0 Form and Instruction 6 Draft Interview Guide
Structural Assessments Modified 376 75 0 Form and Instruction 1 Structural Assessment-Improving Antibiotic Use Cohort-Brick and Mortar Practices
Form and Instruction 2 Structural Assessment - Improving Antibiotic Use Cohort - Telemedicine-Only Organizations
The Medical Office Survey on Patient Safety Culture (MOSOPS) Modified 876 438 0 Form and Instruction 3 Medical Office Survey on Patient Survey
The Office Readiness Survey_Cancer Diagnostic Process Cohort Removed 0 0 0 Form and Instruction 3 Attachment C: The Office Readiness Survey_Cancer Diagnostic Process Cohort
Total burden requested under this ICR: 5508 4644 0  
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