SURVEY OF THE LAST DAYS OF LIFE

ICR 198312-0925-002

OMB: 0925-0203

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
111463
Migrated
ICR Details
0925-0203 198312-0925-002
Historical Active 198304-0925-002
HHS/NIH
SURVEY OF THE LAST DAYS OF LIFE
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 02/07/1984
Retrieve Notice of Action (NOA) 12/12/1983
THIS COLLECTION IS APPROVED FOR USE PROVIDING THAT THE STUDY IS REVISE TO PERMIT ONLY ONE FOLLOW-UP CALL TO THOSE INDIVIDUALS WHO HAVE INDICATED AN UNWILLINGNESS TO PARTICIPATE IN THIS STUDY. TO PERSIST IN CONTACTING INDIVIDUALS WHO HAVE INDICATED A PREFERENCE IS UNNECES SARILY INTRUSIVE AND BURDENSOME AND IT DOES NOT SERVE A COMPELLING RESEARCH PURPOSE.
  Inventory as of this Action Requested Previously Approved
09/30/1985 09/30/1985
1,560 0 0
1,921 0 0
0 0 0

THIS STUDY WILL ADD NEW INFORMATION ON THE CIRCUMSTANCES SURROUNDING DEATH FOR THE ELDERLY. HEALTH PLANNERS, PHYSICIANS, EPIDEMIOLOGISTS, AND GERONTOLOGISTS WILL HAVE PARTICULAR INTERESTS IN THE RESULTS. PERSONS LISTED AS INFORMANTS ON THE SELECTED DEATH CERTIFICATES FROM H 1 ARE ELIGIBLE RESPONDENTS.

None
None


No

1
IC Title Form No. Form Name
SURVEY OF THE LAST DAYS OF LIFE

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,560 0 0 1,560 0 0
Annual Time Burden (Hours) 1,921 0 0 1,921 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/12/1983


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