Core Elements of Antimicrobial Stewardship in Nursing Homes

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Core Elements of Antimicrobial Stewardship in Nursing Homes Form
Prescriber Assessment CDC - Combined Survey_OMB_updated.docx Form
Att B - Email invitation.docx Email invitation IC Document
Att C - Consent Form.docx Consent IC Document
Att D - Non-research determination.pdf Non-research determination IC Document
GenIC Request.docx genIC Request for Approval IC Document
Supporting Statement B_ Nursing Home Antibiotic Stewardship 17MAY2018.docx Supporting Statement B IC Document
Supporting Statement A_Nursing Home Antibiotic Stewardship.docx Supporting Statement A IC Document

Information Collection (IC) Details

IC Title:	Core Elements of Antimicrobial Stewardship in Nursing Homes	Agency IC Tracking Number:	0920-1154-18ADR

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	none	Prescriber Assessment	CDC - Combined Survey_OMB_updated.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 992	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	992	992
Annual IC Time Burden (Hours)	496	496
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Email invitation	Att B - Email invitation.docx	06/14/2018
Consent	Att C - Consent Form.docx	06/14/2018
Non-research determination	Att D - Non-research determination.pdf	06/14/2018
genIC Request for Approval	GenIC Request.docx	06/14/2018
Supporting Statement B	Supporting Statement B_ Nursing Home Antibiotic Stewardship 17MAY2018.docx	06/14/2018
Supporting Statement A	Supporting Statement A_Nursing Home Antibiotic Stewardship.docx	06/14/2018

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