View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Agency IC Tracking Number:	0920-0572-19BSE

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable
Form and Instruction	0920-0572				No		Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 696	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

	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	696	0	696	0	0	0
Annual IC Time Burden (Hours)	186	0	186	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Expedited Review Form		09/27/2019
Study Population		10/01/2019
Incentives Summary		10/01/2019
IRB		09/27/2019
Women Who Primarily Speak Spanish Mod Guide Sp		10/01/2019
Women Who Speak Spanish Screener (Sp)		10/02/2019
Informed Consent		10/02/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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