Information Collection

Evaluating the Effectiveness of Quick Response Codes in Educating Panel Physicians

IC 207440 under ICR 201203-0920-007 · OMB 0920-0932.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0932 can be found here:

Documents and Forms

Document Name Document Type
Evaluating the Effectiveness of Quick Response Codes in Educating Panel Physicians Form and Instruction
Attachment A(3)--In-Depth Interview Guide rev.docx Other-In-Depth Interview Guide
Statement of Consent for Pre-Knowledge Aptitude Survey Attachment A(1)--Screen Shot of Web-Based Pre-Knowledge Survey.docx Form and Instruction
Statement of Consent for Semi-Structured Aptitude Questi Attachment A(2)--Screen Shot of Web-Based Semi-Structured Questionnaire.docx Form and Instruction
ECT Supporting Statement A_QR codes 06112013.docx ECT Supporting Statement A_QR codes 06112013 IC Document
ECT Supporting Statement B_QR codes 06112013.docx ECT Supporting Statement B_QR codes 06112013 IC Document
Attachment B--IRB Determination.docx Attachment B--IRB Determination IC Document
Attachment C(1)13_237881-A PhysicPanelTool.1.pdf Attachment C(1)13_237881-A PhysicPanelTool IC Document
Attachment C(2) 237881-B PhysicansPanelTool2.pdf Attachment C(2) 237881-B PhysicansPanelTool2 IC Document
Attachment C(3)237881-C PhysicansPanelTool3.pdf Attachment C(3)237881-C PhysicansPanelTool3 IC Document
Attachment C(4)237881-D PhysicansPanTool4.pdf Attachment C(4)237881-D PhysicansPanTool4 IC Document
Attachment C(5)237881-E PhysicansPanTool5.pdf Attachment C(5)237881-E PhysicansPanTool5 IC Document
Attachment C(6)13_237881-F PhysicPanelTool6.1_DS.pdf Attachment C(6)13_237881-F PhysicPanelTool6 IC Document
Attachment C(7)13_237881-F PhysicPanelTool6.2_DS2.pdf Attachment C(7)13_237881-F PhysicPanelTool6 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluating the Effectiveness of Quick Response Codes in Educating Panel Physicians	Agency IC Tracking Number:

IC Status: New

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	None	Statement of Consent for Pre-Knowledge Aptitude Survey	Attachment A(1)--Screen Shot of Web-Based Pre-Knowledge Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	None	Statement of Consent for Semi-Structured Aptitude Questionnaire	Attachment A(2)--Screen Shot of Web-Based Semi-Structured Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-In-Depth Interview Guide			Attachment A(3)--In-Depth Interview Guide rev.docx	Yes	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Records of Health Professionals in Disease Prevention and Control Training Programs	FR Citation: 51 FR 42485

Number of Respondents: 210	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

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	210	0	0	0	0	0
Annual IC Time Burden (Hours)	71	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
ECT Supporting Statement A_QR codes 06112013	ECT Supporting Statement A_QR codes 06112013.docx	06/11/2013
ECT Supporting Statement B_QR codes 06112013	ECT Supporting Statement B_QR codes 06112013.docx	06/11/2013
Attachment B--IRB Determination	Attachment B--IRB Determination.docx	06/11/2013
Attachment C(1)13_237881-A PhysicPanelTool	Attachment C(1)13_237881-A PhysicPanelTool.1.pdf	06/11/2013
Attachment C(2) 237881-B PhysicansPanelTool2	Attachment C(2) 237881-B PhysicansPanelTool2.pdf	06/11/2013
Attachment C(3)237881-C PhysicansPanelTool3	Attachment C(3)237881-C PhysicansPanelTool3.pdf	06/11/2013
Attachment C(4)237881-D PhysicansPanTool4	Attachment C(4)237881-D PhysicansPanTool4.pdf	06/11/2013
Attachment C(5)237881-E PhysicansPanTool5	Attachment C(5)237881-E PhysicansPanTool5.pdf	06/11/2013
Attachment C(6)13_237881-F PhysicPanelTool6	Attachment C(6)13_237881-F PhysicPanelTool6.1_DS.pdf	06/11/2013
Attachment C(7)13_237881-F PhysicPanelTool6	Attachment C(7)13_237881-F PhysicPanelTool6.2_DS2.pdf	06/11/2013

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