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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Testing Solutions for Sampling Challenges for MMP
Agency IC Tracking Number:
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
none
2a - Interview questionnaire - English
MMP GenIC_Testing Sampling_Att 2a_MMP Formative Research Interview_English.docx
Yes
Yes
Fillable Fileable
Form
none
2b - interview questionnaire - Spanish
MMP GenIC_Testing Sampling_Att 2b_MMP Formative Research Interview_Spanish.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,850
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
2,850
0
0
0
0
0
Annual IC Time Burden (Hours)
983
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A
MMP GenIC_Testing Sampling_Supporting Statement A.docx
06/24/2013
Supporting Statement B
MMP GenIC_Testing Sampling_Supporting Statement B.docx
06/24/2013
1 - Authorizing Legislation
MMP GenIC_Testing Sampling_Att 1_Research Sect 301 PHSA.pdf
06/24/2013
3a - MMP Medical Record Abstraction form
MMP GenIC_Testing Sampling_Att 3a_MMP_2013_MRA_MHF_v7 1 0.doc
06/24/2013
3b - MMP Surveillance Summary Form
MMP GenIC_Testing Sampling_Att 3b_MMP_2013_MRA_SPSF_v7 1 0.doc
06/24/2013
3c - MMP Surveillance Visit Form
MMP GenIC_Testing Sampling_Att 3c_MMP_2013_MRA_SPVF_v7 1 0.doc
06/24/2013
3d - MMP Surveillance Inpatient Form
MMP GenIC_Testing Sampling_Att 3d_MMP_2013_MRA_SPIF_v7 1 0.doc
06/24/2013
4a - MMP variables
MMP GenIC_Testing Sampling_Att 4a_MMP_MDS Person level variables_eHARS.docx
06/24/2013
4b - MMP variables
MMP GenIC_Testing Sampling_Att 4b_MMP_MDS Person level variables based on eHARS.docx
06/24/2013
4c - MMP variables
MMP GenIC_Testing Sampling_Att 4c_MMP_MDS Lab level variables.docx
06/24/2013
5a - Process documentation form
MMP GenIC_Testing Sampling_Att 5a MMP_Research Process Doc Form.docx
06/24/2013
5b - Contact attempt tracking
MMP GenIC_Testing Sampling_Att 5b MMP_Contact Attempt Tracking Database.docx
06/24/2013
6a - Assurance of Confidentiality
MMP GenIC_Testing Sampling_Att 6a_MMP_Assurance of Conf.doc
06/24/2013
6b - Authorization to Operate
MMP GenIC_Testing Sampling_Att 6b_MMP_DCC_Auth to operate.pdf
06/24/2013
7 - Recruitment script
MMP GenIC_Testing Sampling_Att 7_MMP_Recruitment Guidance_First Contact.docx
06/24/2013
8 - Data release agreement
MMP GenIC_Testing Sampling_Att 8_MMP_Data Release Agreement.doc
06/24/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.