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

View Information Collection (IC)

Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers 0920-17ATK
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Screener for Consumers (Self-demanders and Self-expectors) Attach 2_Consumer Screener SD-SE FINAL 062117.doc No   Paper Only
Form and Instruction n/a Screener for Consumers (Caregiver-demanders and Caregiver-expectors) Attach 3_Consumer Screener CD-CE FINAL 062117.doc No   Paper Only
Form and Instruction n/a Pre-discussion Information Survey for Consumers (Self-demanders and Self-expectors) Attach 4_Consumer PDIS SE-SD FINAL 0062117.doc No   Paper Only
Form and Instruction n/a Pre-discussion Information Survey for Consumers (Caregiver-demanders and Caregiver-expectors) Attach 5_Consumer PDIS CE-CD FINAL 062117.doc No   Paper Only
Form and Instruction n/a Online Focus Group Guide for Consumers Attach 6_Consumer Triad Guide_FINAL_062117.docx Yes No Fillable Printable

Health Illness Prevention

 

180 0
   
Individuals or Households
 
   20 %

  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 180 0 180 0 0 0
Annual IC Time Burden (Hours) 69 0 69 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Project Description Attach 1_AU R2 Consumer Project Desc_062117.docx 06/22/2017
HMTS Expedited Review form (AU R2/Consumers) HMTS Expedited Review Form - AU R2 Campaign - Consumers 062217.pdf 06/22/2017
Verbal Consent Attach 7_Verbal Consent IDI-FG FINAL 062117.docx 06/22/2017
Observer Confidentiality Agreement Attach 8_Observer Confidentiality_FINAL 062117.doc 06/22/2017
Test Item 1. Print Ad_Safe Play 1.AU PSA Print Ad_Safe Play.pdf 06/22/2017
Test Item 2. Print Ad_Status Update 2.AU PSA Print Ad_Status Update.pdf 06/22/2017
Test Item 3. Print Ad_The Right Tool 3.AU PSA Print Ad_The Right Tool.pdf 06/22/2017
Test Item 4. Campaign Stimulus_TV Ads 4.AU Campaign Stimulus_TV Ads.docx 06/22/2017
Test Item 5. Visual with slogan_A 5.Visual with slogan_A.png 06/22/2017
Test Item 6. Visual with slogan_B 6.Visual with slogan_B.png 06/22/2017
Test Item 7. Visual with slogan_C 7.Visual with slogan_C.png 06/22/2017
Test Item 8. Visual with slogan_D 8.Visual with slogan_D.jpg 06/22/2017
Test Item 9. Visual with slogan_E 9.Visual with slogan_E.jpg 06/22/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.