[NCEZID] Public Health Communications Messages and Materials Testing Focused on Antimicrobial Resistance Among the U.S. General Population Pilot Data Collection Project

[OS] CDC/ATSDR Formative Research and Tool Development

Documents and Forms

Document Name Document Type
[NCEZID] Public Health Communications Messages and Materials Testing Focused on Antimicrobial Resistance Among the U.S. General Population Pilot Data Collection Project Form and Instruction
Recruitment Screener Attachment A_ARX_Task1_Panel Provider Recruitment Screener_FINAL 7-28-2023.docx Form and Instruction
Technology Pre-check Attachment D_ARX_Task1_Technology Check Email & Check List_FINAL 07-28-2023.docx Form and Instruction
AR Formative Evaluation Interview Guide Attachment C_ARX_Task1_DiscussionGuide_Final_OMB 07-28-2023.docx Form and Instruction
Attachment B_ARX_Task1_Informed Consent Form_FINAL Focus Grps 7-28-2023.docx Informed Consent IC Document
Attachment E_Kopf Protocol Exempt Determination Notice Feb2423.pdf Research Determination IC Document
Attachment F_ARX_Task1_Informed Consent Form-IDI 7-28-2023.docx Informed Consent (IDI) IC Document
GenIC Request Template_ARX 07-28-2023_final.docx GenIC Request Template IC Document
Supporting Statement A (0920-1154) 07-28-2023_final.docx SSA IC Document
Supporting Statement B (0920-1154) 07-28-2023.docx SSB IC Document

Information Collection (IC) Details

IC Title:	[NCEZID] Public Health Communications Messages and Materials Testing Focused on Antimicrobial Resistance Among the U.S. General Population Pilot Data Collection Project	Agency IC Tracking Number:	0920-1154-23HK

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Recruitment Screener	Attachment A_ARX_Task1_Panel Provider Recruitment Screener_FINAL 7-28-2023.docx	Yes	No	Fillable Fileable
Form and Instruction	n/a	Technology Pre-check	Attachment D_ARX_Task1_Technology Check Email & Check List_FINAL 07-28-2023.docx	Yes	No	Fillable Fileable
Form and Instruction	n/a	AR Formative Evaluation Interview Guide	Attachment C_ARX_Task1_DiscussionGuide_Final_OMB 07-28-2023.docx	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,590	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 5 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,590	1,590
Annual IC Time Burden (Hours)	306	306
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Informed Consent	Attachment B_ARX_Task1_Informed Consent Form_FINAL Focus Grps 7-28-2023.docx	08/09/2023
Research Determination	Attachment E_Kopf Protocol Exempt Determination Notice Feb2423.pdf	08/09/2023
Informed Consent (IDI)	Attachment F_ARX_Task1_Informed Consent Form-IDI 7-28-2023.docx	08/09/2023
GenIC Request Template	GenIC Request Template_ARX 07-28-2023_final.docx	08/09/2023
SSA	Supporting Statement A (0920-1154) 07-28-2023_final.docx	08/09/2023
SSB	Supporting Statement B (0920-1154) 07-28-2023.docx	08/09/2023

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