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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NCEZID] Interviews with Healthcare Providers to Inform Fungal Infection Communications
Agency IC Tracking Number:
0920-1154-25-0047
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
0920-1154
Healthcare Professionals (physicians, PAs, NPs - Screener
Attachment 1_DFWED_IDI Screener_FINAL_2.12.25.docx
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Primary Care Physician - Ringworm IDI Discussion Guide
Attachment 3_DFWED_Ringworm IDI Discussion Guide_FINAL_2.12.25 (1).docx
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Primary Care Physician - Vulvovaginal Candidiasis (VVC) IDI Discussion Guide
Attachment 4_DFWED_VVC IDI Discussion Guide_FINAL_2.12.25 (1).docx
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
OB-GYN Physicians - Vulvovaginal Candidiasis (VVC) IDI Discussion Guide
Attachment 4_DFWED_VVC IDI Discussion Guide_FINAL_2.12.25 (1).docx
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Physicians Associates/Assistants - Ringworm IDI Discussion Guide
Attachment 3_DFWED_Ringworm IDI Discussion Guide_FINAL_2.12.25 (1).docx
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Physicians Associates/Assistants - Vulvovaginal Candidiasis (VVC) IDI Discussion Guide
Attachment 4_DFWED_VVC IDI Discussion Guide_FINAL_2.12.25 (1).docx
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Nurse Practitioners - Ringworm IDI Discussion Guide
Attachment 3_DFWED_Ringworm IDI Discussion Guide_FINAL_2.12.25 (1).docx
N/A
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Nurse Practitioners - Vulvovaginal Candidiasis (VVC) IDI Discussion Guide
Attachment 4_DFWED_VVC IDI Discussion Guide_FINAL_2.12.25 (1).docx
N/A
Yes
Yes
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:
240
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
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
240
0
240
0
0
0
Annual IC Time Burden (Hours)
57
0
57
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A
DFWED_OMB Supporting Statement A_FINAL_3.6.25.docx
03/11/2025
Supporting Statement B
DFWED_OMB Supporting Statement B_FINAL_2.12.25.docx
03/11/2025
Consent Form
Attachment 2_DFWED_IDI Consent Form_FINAL_2.12.25.docx
03/11/2025
Non-Research Determination
Attachment 5_Human Subjects Determination.pdf
03/11/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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The .gov means it's official.
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