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View Information Collection (IC)

Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures – Comprehension 0920-0572-19PP
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0572 HMTS Evaluation Screener Attachment 1 - CDC Fact Sheet IDI Screener_11-19-18.doc NA Yes Yes Fillable Fileable
Form and Instruction 0920-0572 HMTS Evaluation Consent Form Attachment 2 - CDC Fact Sheet Consent Form_12-12-18.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-0572 HMTS Worksheet Activity Attachment 4 - CDC Fact Sheet Worksheet Activity_11-19-18.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-0572 HMTS Evaluation IDI Guide Attachment 3 - CDC Fact Sheet IDI Guide_12-11-18.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

285 0
   
Individuals or Households
 
   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 285 0 285 0 0 0
Annual IC Time Burden (Hours) 119 0 119 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Screener Invitatioin Email Attachment 5 - CDC Fact Sheet Screener Invitation Email_10-1-2018.docx 02/04/2019
IDI Confirmation Email Attachment 6 - CDC Fact Sheet IDI Confirmation Email_12-11-18.docx 02/04/2019
Non-Research Determination Non-research determination_CDC NCEZID Human Subjects_121418_signed.pdf 02/04/2019
GenIC Request - HMTS Expedited Review HMTS Expedited Review Form_OMB_Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures 04FEB2019.pdf 02/04/2019
Fact Sheet - Anthrax_Amoxicillin Anthrax_Amoxicillin EUA Recipient FS_draft 05Oct18.pdf 02/04/2019
Fact Sheet - Anthrax_AVA Anthrax_AVA Dose-sparing EUA Recipient FS_draft 26Sept18.pdf 02/04/2019
Fact Sheet - Anthrax_Doxycycline Anthrax_Doxycycline EUI Recipient FS_draft 05Oct18.pdf 02/04/2019
Fact Sheet - Botulism_BAT Botulism_BAT EUI Recipient FS_draft 04Oct18.pdf 02/04/2019
Fact Sheet - Burkholderia_Bactrim Burkholderia_Bactrim EUA Recipient FS_draft 20Sept17.pdf 02/04/2019
Fact Sheet - Burkholderia_Meropenem Burkholderia_Meropenem EUA Recipient FS_draft 28Mar18.pdf 02/04/2019
Fact Sheet - Influenza_IV Zanamivir Influenza_IV Zanamivir EUA Recipient FS_draft 20Sept18.pdf 02/04/2019
Fact Sheet - Influenza_Oseltamivir Influenza_Oseltamivir EUI Recipient FS_draft 24Oct18.pdf 02/04/2019
Fact Sheet - Influenza_Peramivir Influenza_Peramivir EUI Recipient FS_draft 24Oct18.pdf 02/04/2019
Fact Sheet - Plague_Ciprofloxacin Plague_Ciprofloxacin_EUI Recipient FS_draft 27Feb18.pdf 02/04/2019
Fact Sheet - Radiation_Neupogen Radiation_Neupogen EUI Recipient FS_draft 24Oct18.pdf 02/04/2019
Fact Sheet - Radiation_Radiogardase Radiation_Radiogardase EUA Recipient FS_draft 23Oct18.pdf 02/04/2019
Fact Sheet - Smallpox_ACAM2000 Smallpox_ACAM2000 EUI Recipient FS_draft 24July18.pdf 02/04/2019
Fat Sheet - Smallpox_Tecovirimat Smallpox_Tecovirimat EUI Recipient FS_draft 15Oct18.pdf 02/04/2019
Fact Sheet - Tularemia_Gentamicin Tularemia_Gentamicin EUA Recipient FS_draft 01Oct18.pdf 02/04/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.