View Information Collection (IC)

View Information Collection (IC)

IC Title:	Instruments for Wave 3 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	PATH Data Collection Instruments for Wave 3 English and Spanish Versions	2 PATH Study Data Collection Instruments.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	Follow up, Retention and Tracking Documents - English Version	9 Followup, Retention, and Tracking Materials.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 Clinical, Basic and Population-based Research Studies of 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)	54,434	0	-4,589	0	0	59,023
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Summary of Changes to the Instrument for Wave 3	5 Summary of Changes to PATH Study Instruments.pdf	06/19/2015
Additional Biospecimen Information for Wave 3	6 Additional Information on Biospecimens.pdf	06/19/2015
Field Materials - English and Spanish for Wave 3	19 Field Data Collection Materials.pdf	06/19/2015
Data Confidentially Procedures for Wave 3	17 Procedures for Keeping Data Confidential.pdf	06/19/2015
Data Use Agreement for Wave 3	18 ICPSR Data Use Agreement.pdf	06/19/2015
Key Survey Design Features for Wave 3	8 Key Design Features.pdf	06/19/2015

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