View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Sepsis Campaign Development: Round 2 Concept/Materials Testing for Healthcare Providers 0920-17AGZ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form n/a Screenshots of the Sepsis Survey for Healthcare Professionals A.R2 Sepsis HCP Survey Screenshots.pdf Yes Yes Fillable Fileable

Health Illness Prevention

 

462 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 462 0 462 0 0 0
Annual IC Time Burden (Hours) 56 0 56 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Project Description for Sepsis R2 Testing with HCP Sepsis R2 Project Description_5.31.2017 - HCP.docx 06/05/2017
Justification for the Proposed Incentive Sepsis_R2 Incentive Justification_5.31.2017- HCP.docx 06/05/2017
Test Item C1. Visual with Slogan_A C1.Visual with slogan_A.png 06/05/2017
Test Item C2. Visual with Slogan_B C2.Visual with slogan_B.png 06/05/2017
Test Item C3. Visual with Slogan_C C3.Visual with slogan_C.png 06/05/2017
Test Item C4. Visual with Slogan_D C4.Visual with slogan_D.png 06/05/2017
Test Item C5. Visual with Slogan_E C5.Visual with slogan_E.png 06/05/2017
Test Item C6. Print Concept_A C6.Sepsis_Print_Concept_A.pdf 06/05/2017
Test Item C7. Print Concept_B C7.Sepsis_Print_Concept_B.pdf 06/05/2017
Test Item C8. Print Concept_C C8.Sepsis_Print_Concept_C.pdf 06/05/2017
Test Item C9. Campaign Stimulus_TV Ads C9.Sepsis Campaign Stimulus_TV Ads.docx 06/05/2017
Test Item C10. Sepsis Flier for R2 Testing C10.HCP Sepsis flier for R2 testing_FINAL.docx 06/05/2017
HMTS Form - Sepsus R2 Testing with HCP Sepsis R2_HMTSExpeditedReviewForm_v4 - HCP.pdf 06/05/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.