PIEDMONT HEALTH SURVEY OF THE ELDERLY

ICR 199304-0925-002

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
165875
Migrated
ICR Details
0925-0267 199304-0925-002
Historical Active 199108-0925-003
HHS/NIH
PIEDMONT HEALTH SURVEY OF THE ELDERLY
No material or nonsubstantive change to a currently approved collection   No
Emergency 04/27/1993
Approved with change 04/27/1993
Retrieve Notice of Action (NOA) 04/27/1993
  Inventory as of this Action Requested Previously Approved
12/31/1993 12/31/1993 09/30/1993
2,086 0 2,086
3,463 0 3,463
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 2,086 0 0 0 0
Annual Time Burden (Hours) 3,463 3,463 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
04/27/1993


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