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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Instruments for Wave 2 of the PATH Study
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
1-Rev
English Version
2_PATH_Study_Data_Collection_Instruments.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
1
Spanish Version
2-PATH_Study_Data_Collection_Instruments-Spanish.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
2
Follow up, Retention and Tracking Documents - English Version
9_Follow-up_Retention_and_Tracking.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
2
Follow up, Retention and Tracking Documents - Spanish Version
9_Follow-up_Retention_and_Tracking_Spanish.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
3-New
PATH Verification Form
23_PATH Verification Form (new) 5-8-15.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
3-New
PATH Validation Form
24_PATH Validation Form (new) 5-8-15.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-25-0200 ooClinical, Basic and Population-basedR esearchS tudieso f the National Institutes of Health (NIH), HHSAIIH/OD
FR Citation:
67 FR 60741
Number of Respondents:
41,662
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
90 %
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
192,858
0
0
0
0
192,858
Annual IC Time Burden (Hours)
59,023
0
683
0
0
58,340
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Summary of Changes to the Instrument
5 Summary of Changes to Instruments for W2 6-27-2014.pdf
07/31/2014
Additional Biospecimen Informatiion
6_Additional_Information_on_Biospecimens.pdf
07/31/2014
Field Materials - English
19_Field_Data_Collection_Materials.pdf
07/31/2014
Field Materials - Spanish
19_Field_Data_Collection_Materials_Spanish.pdf
07/31/2014
Data Confidentially Procedures
17_Procedures_for_Keeping_Data_Confidential.pdf
07/31/2014
Data Use Agreement
18_ICPSR_Data_Use_Agreement.pdf
07/31/2014
Key Survey Design Features
8_Key_Design_Features.pdf
07/31/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.