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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
MUltimorbidity and Medications: the unheard perspective of older Under-Represented Racial and Ethnic Minority Adults
Agency IC Tracking Number:
OC
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
Other-Invitation letter
1. MUM-URMA1 Invitation Letter 9-13-2022.docx
Yes
No
Printable Only
Other-Invitation letter (Traditional Chinese)
1a. MUM-URMA1 Invitation Letter (Traditional-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Invitation letter (Simplified Chinese)
1b. MUM-URMA1 Invitation Letter (Simplified-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Information sheet
2. MUM-URMA1 Information Sheet 9-13-2022.docx
Yes
No
Printable Only
Other-Information sheet (Traditional Chinese)
2a. MUM-URMA1 Information Sheet (Traditional-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Information sheet (Simplified Chinese)
2b.MUM-URMA1 Information Sheet (Simplified-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Phone Recruitment and Screening
3. MUM-URMA1 Phone Recruitment and Screening 9-13-2022.docx
Yes
Yes
Fillable Fileable
Other-Phone Recruitment and Screening (Traditional Chinese)
3a. MUM-URMA1 Phone Recruitment and Screening (Traditional-chinese) 9-13-2022.docx
Yes
Yes
Fillable Fileable
Other-Phone Recruitment and Screening (Simplified Chinese)
3b. MUM-URMA1 Phone Recruitment and Screening (Simplified-chinese) 9-13-2022.docx
Yes
Yes
Fillable Fileable
Other-Recruitment Flyer
4. MUM-URMA1 Recruitment Flyer 9-13-2022.docx
Yes
No
Printable Only
Other-Recruitment Flyer (Traditional Chinese)
4a. MUM-URMA1 Recruitment Flyer (Traditional-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Recruitment Flyer (Simplified Chinese)
4b. MUM-URMA1 Recruitment flyer.word (Simplified-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Newsletter Advertisement
5. MUM-URMA1 Newsletter Advertisement.docx
Yes
No
Printable Only
Other-Newsletter Advertisement (Traditional Chinese)
5a. MUM-URMA1 Newsletter Advertisement (Traditional-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Newsletter Advertisement (Simplified Chinese)
5b. MUM-URMA1 Newsletter Advertisement (Simplified-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Newspaper Recruitment Advertisement
6. MUM-URMA1 Newspaper Recruitment Advertisement.docx
Yes
No
Printable Only
Other-Newspaper Recruitment Advertisement (Traditional Chinese)
6a. MUM-URMA1 Newspaper Recruitment Advertisement (Traditional-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Newspaper Recruitment Advertisement (Simplified Chinese)
6b. MUM-URMA1 Newspaper Recruitment Advertisement (Simplified-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Verbal Presentation Script Recruitment
7. MUM-URMA1 Verbal Presentation 9-13-2022.docx
Yes
No
Printable Only
Other-Verbal Presentation Script Recruitment (Traditional Chinese)
7a. MUM-URMA1 Verbal Presentation (Traditional-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Verbal Presentation Script Recruitment (Simplified Chinese)
7b. MUM-URMA1 Verbal Presentation (Simplified-chinese) 9-13-2022.docx
Yes
No
Printable Only
Other-Moderator Guide
8. MUM-URMA1 Moderator Guide 9-13-2022.docx
Yes
Yes
Fillable Fileable
Other-Moderator Guide (Traditional Chinese)
8a. MUM-URMA1 Moderator Guide (Traditional-chinese) 9-13-2022.docx
Yes
Yes
Fillable Fileable
Other-Moderator Guide (Simplified Chinese)
8b. MUM-URMA1 Moderator Guide (Simplified-chinese) 9-13-2022.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
250
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
250
0
250
0
0
0
Annual IC Time Burden (Hours)
169
0
169
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB Memo - MUltimorbidity and Medications: the unheard perspective of older Under-Represented Racial and Ethnic Minority Adults
MUM-URMA1 OMB memo 9-19-2022 final.docx
09/23/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.