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

View Information Collection (IC)

Be Antibiotic Aware Campaign 0920-0572-19BQR
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Focus group guide Att 1 - Mod Guide for Adults 65+.docx Yes No Paper Only
Form and Instruction none Screener for adults Att 2 - Screener for Adults 65+.docx Yes Yes Fillable Fileable
Other-Focus group guide Att 3 - Mod Guide for Nursing Home Caregivers.docx Yes No Paper Only
Form and Instruction none Screener for Nursing Home Caregivers Att 4 - Screener for Nursing Home Caregivers.docx Yes Yes Fillable Fileable
Other-Focus group guide Att 5 - Mod Guide for SS Women_EN.docx Yes No Paper Only
Other-Focus group guide Att 6 - Mod Guide for SS Women_SP.docx Yes No Paper Only
Form and Instruction none Screener for SS women - English Att 7 - Screener for SS Women_EN.docx Yes Yes Fillable Fileable
Form and Instruction none Screener for SS Women - Spanish Att 8 - Screener for SS Women_SP.docx Yes Yes Fillable Fileable
Other-Focus group guide Att 11 - Mod Guide for Urgent Care Adults.docx Yes No Paper Only
Form and Instruction none Screener for Urgent Care adults Att 12 - Screener for Urgent Care Adults.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

464 0
   
Individuals or Households
 
   86 %

  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 464 0 464 0 0 0
Annual IC Time Burden (Hours) 129 0 129 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Consent for SS women - English Att 9 - Informed Consent for SS Women_EN.docx 09/12/2019
Consent for SS women - Spanish Att 10 - Informed Consent for SS Women_SP.docx 09/12/2019
Consent for consumers Att 13 - Consumer Informed Consent.docx 09/12/2019
Brochure - Abx side effects - adults Att 14 - Adults 65+ Abx Side Effects.pdf 09/12/2019
Brochure - AU - adults Att 15 - Adults 65+ AU Brochure.pdf 09/12/2019
Brochure - Viral illnes Rx Pad - adults Att 16 - Adults 65+ Viral Illnesses Rx Pad.pdf 09/12/2019
Brochure - What's got you sick - adults Att 17 - Adults 65+ What's Got You Sick.pdf 09/12/2019
Brochure - Abx side effects - caregivers Att 18 - Caregivers-Abx Side Effects.pdf 09/12/2019
Brochure - AU - caregivers Att 19 - Caregivers-AU NH Brochure.pdf 09/12/2019
Brochure - Commitment about Abx - caregivers Att 20 - Caregivers-Committment about Abx.pdf 09/12/2019
Brochure - What's got you sick - caregivers Att 21 - Caregivers-What's Got You Sick.pdf 09/12/2019
Brochure - AU - SS women Att 22 - SS Women-AU Brochure.pdf 09/12/2019
Brochure - Viral illness Rx Pad - SS women Att 23 - SS Women-Viral Illness Rx Pad.pdf 09/12/2019
Brochure - What's got you sick - SS women Att 24 - SS Women-What's Got You Sick.png 09/12/2019
Brochure - AU - urgent care Att 25 - Urgent Care-AU Brochure.pdf 09/12/2019
Brochure - What is AR bacteria - urgent care Att 26 - Urgent Care-What is AR Bacteria.pdf 09/12/2019
Brochure - Viral illness Rx Pad - urgent care Att 27 - Urgent Care-Viral Illnesses Rx Pad.pdf 09/12/2019
Brochure - What's got you sick - urgent care Att 28 - Urgent Care-What's Got You Sick.pdf 09/12/2019
Attachment A HMTS Expedited Review Form - Attachment A.docx 09/12/2019
Attachment B HMTS Expedited Review Form - Attachment B.docx 09/12/2019
genIC Request Form HMTS Expedited Review Form - AU Consumer Audiences.pdf 09/12/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.