Validated Interview and Survey of Outpatient Providers on Antibiotic Stewardship Interventions

Forms and Documents

Document Name	Status
Survey Form	New
Supporting Statement A 02Jun2020.docx Supporting Statement A	2020-06-04
SSA Attachment 5 - Data Collection Recruitment E-mail Templates 29May2020.docx Supplementary Document	2020-06-04
SSA Attachment 4 IRB Approved Consent Cover Letter.pdf Supplementary Document	2020-06-04
SSA Attachment 2 Published 60-Day FRN.pdf Supplementary Document	2020-06-04
SSA Attachment 1 Authorizing Legislation.pdf Supplementary Document	2020-06-04
Supporting Statement B 02Jun2020.docx Supporting Statement B	2020-06-04

IC Document Collections

IC ID	Document Title	Status
242164	Survey Form	New
242163	Interview guide Other-Interview guide	New

ICR Details

OMB Control No: 0920-1308	ICR Reference No: 202006-0920-004
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-20GX
Title: Validated Interview and Survey of Outpatient Providers on Antibiotic Stewardship Interventions
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/06/2020
	Date Received in OIRA: 07/06/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2021	12 Months From Approved
Responses	290	0	0
Time Burden (Hours)	207	0	0
Cost Burden (Dollars)	14,998	0	0

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Abstract: Proposed information collection will allow Intermountain Healthcare to identify barriers and facilitators after the implementation of an antibiotic stewardship program in the urgent care setting of participating clinics. The interview responses will allow researchers to identify themes to which they will adapt surveys. The surveys will be designed to increase researchers understanding of the knowledge, attitudes, and practices associated with stewardship implementation. This understanding will increase researchers' capacity to detect, monitor, and combat antimicrobial resistance.

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Authorizing Statute(s): US Code: 42 USC 247d Name of Law: Combating antimicrobial resistance
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 7556	02/10/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 40291	07/06/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Interview guide
Survey	none	Survey

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	290	0	0	290	0	0
Annual Time Burden (Hours)	207	0	0	207	0	0
Annual Cost Burden (Dollars)	14,998	0	0	14,998	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $35,420

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/06/2020

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