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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
MD STARnet Women Living with Muscular Dystrophy Survey
Agency IC Tracking Number:
Is this a Common Form?
No
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
None
Women Living with Muscular Dystrophy Survey (paper)
Attachment D_MD STARnet Women Living with MD Survey.docx
No
Paper Only
Form and Instruction
None
Women Living with Muscular Dystrophy Survey (screen shot of intro to the web-based form)
2023 2 13 Attachment D-2_Introduction to Women's Web-based Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Women Living with Muscular Dystrophy Survey (telephone interview)
2013 2 13 Attachment F_MD STARnet Women Living with MD Phone Script.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:
472
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
472
0
472
0
0
0
Annual IC Time Burden (Hours)
157
0
157
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.