PIEDMONT HEALTH SURVEY OF THE ELDERLY

ICR 199108-0925-003

OMB: 0925-0267

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
111549
Migrated
ICR Details
0925-0267 199108-0925-003
Historical Active 199010-0925-001
HHS/NIH
PIEDMONT HEALTH SURVEY OF THE ELDERLY
Revision of a currently approved collection   No
Regular
Approved without change 11/27/1991
Retrieve Notice of Action (NOA) 08/30/1991
This information collection is approved with the understanding that questions 72a through 72e will be amended consistent with representa- tive question contained in HHS November 27th Facsimile transmission.
  Inventory as of this Action Requested Previously Approved
09/30/1993 09/30/1993 07/31/1992
2,086 0 2,256
3,463 0 440
0 0 0

THIS PROSPECTIVE EPIDEMIOLOGIC STUDY IS COMPARING AND CONTRASTING THE INFLUENCES OF PHYSIOLOGICAL, BEHAVIORAL, SOCIAL, AND ENVIRONMENTAL FORCES ON THE MORTALITY, MORBIDITY, AND UTILIZATION OF HEALTH SERVICES FOR ELDERLY BLACKS AND WHITES. THE PARTICIPANTS ARE SAMPLED FROM THE FIVE COUNTIE OF DURHAM, GRANVILLE, VANCE, WARREN, AND FRANKLIN IN NORTH CAROLINA.

None
None


No

1
IC Title Form No. Form Name
PIEDMONT HEALTH SURVEY OF THE ELDERLY

  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 2,086 2,256 0 -170 0 0
Annual Time Burden (Hours) 3,463 440 0 3,023 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.
08/30/1991


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