View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

My Family Health Portrait Usability Study 0920-1050-24GE
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1050 Pre-Study Meeting Attachment 3_Pre study meeting.docx N/A Yes Yes Fillable Fileable
Form and Instruction 0920-1050 Week 1 Task Questions Attachment 4a_Week 1_Task_Questions.docx N/A Yes Yes Fillable Fileable
Form and Instruction 0920-1050 Weeks 2-3 Task Questions Attachment 5a_Weeks 2_3 task questions.docx N/A Yes Yes Fillable Fileable
Form and Instruction 0920-1050 Weeks 4-5 Task Questions Attachment 6a_Weeks 4_5 task questions.docx N/A Yes Yes Fillable Fileable
Form and Instruction 0920-1050 Post-Study Interview Attachment 7_Post study interview.docx N/A Yes Yes Fillable Fileable
Form and Instruction 0920-1050 Recruitment Screener Attachment 1_Recruitment Screener_REVISED.docx N/A Yes Yes Fillable Fileable

Health Health Care Services

 

160 0
   
Individuals or Households
 
   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 160 0 160 0 0 0
Annual IC Time Burden (Hours) 137 0 137 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Week 1 Email Reminder Attachment 4b_Week 1 emails (initial and reminder).docx 06/05/2024
Weeks 2-3 Email Reminder Attachment 5b_Weeks 2_3 emails (weekly and reminder).docx 06/05/2024
Weeks 4-5 Email Reminder Attachment 6b_Weeks 4_5 emails (weekly and reminder).docx 06/05/2024
MFHP Study Overview Appendix_A_MFHP Study_Overview.docx 06/05/2024
MFHP Screener Details Appendix_B_MFHP_Screener_Details.docx 06/05/2024
MFHP Study Design Graphic Attachment 1a_Study Design Graphic.docx 06/05/2024
MFHP Consent Form Attachment 2_Consent form.docx 06/05/2024
0920-1050 GenIC Request Template GenIC Template_MFHP Usability Study.docx 06/20/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.