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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Health Education and Health Promotion in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Knowledge, Attitudes and Beliefs in the U.S. General Public
Agency IC Tracking Number:
0920-21AS
IC Status:
New
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
n/a
Screener
5_Attachment2__HEHP_MECFS_KAB_Pilot_Screener_20201029.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Survey
6_Attachment3__HEHP_MECFS_KAB_Pilot_Survey_20201123.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
3,800
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
3,800
0
3,800
0
0
0
Annual IC Time Burden (Hours)
530
0
530
0
0
0
Annual IC Cost Burden (Dollars)
13,249
0
13,249
0
0
0
Documents for IC
Title
Document
Date Uploaded
GENIC Template with Project Description
3_GenICRequest_HEHP_MECFS_KAB_Pilot_20201201.docx
12/01/2020
Supporting Statement A: Justification
1_SSA_HEHP_MECFS_KAB_Pilot_20201201.docx
12/01/2020
Supporting Statement B: Statistical Methods
2_SSB_HEHP_MECFS_KAB_Pilot_20201123.docx
12/01/2020
Invitation to Potential Participants
4_Attachment1__HEHP_MECFS_KAB_Pilot_Invitation.docx
12/01/2020
Human Subjects Determination: IRB Approval Not Required
7_Attachment4_Human_Subjects_Review.pdf
12/01/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.