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Bundled sub-studies #17 (CIS) and #18 (Message)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 #17 Email Form and Survey #17_Attach 17C Email Form and 17D Survey_CIS.docx Yes Yes Fillable Fileable
Form and Instruction 2 #18 Moderator's Guide and Screener #18_Attach 18B guide & 18C Screener.docx Yes No Fillable Printable

Health Consumer Health and Safety

SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"   67 FR 60743

335 0
   
Individuals or Households
 
   60 %

  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 335 0 0 0 0 0
Annual IC Time Burden (Hours) 156 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Memo to OMB_Key To Bundle #17 & 18 Memo to OMB_Key To Bundle #17 & 18.doc 07/27/2011
#17 and #18_Gen Sub-Study Form_CIS and Message #17 and #18_Gen Sub-Study Form_CIS and Message.doc 07/27/2011
#17_Justif memo & Attach 17A and17 B_CIS_7-27-2011 #17_Justif memo & Attach 17A and17 B_CIS_7-27-2011.docx 07/27/2011
#18_Justif Memo & Attach 18A Themes 18D Consent_Message #18_Justif Memo & Attach 18A Themes 18D Consent_Message.doc 07/27/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.