Information Collection

Follow-up Study of Chronic Fatigue Syndrome in Georgia (Survey of Chronic Fatigue Syndrome & Chronic Unwellness in Georgia-Base Line Survey)

IC 7106 under ICR 200712-0920-006 · OMB 0920-0638.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 3 Questionnair for Telephone Interview.doc	Instruction
Attachment 6 Advance Letter.doc Attachment 6 Advance Letter	IC Document
Attachment 7A Non-Contact Letter.doc Attachment 7A. Non-Contact Letter	IC Document
Attachment 7B Refusal Letter.doc Attachment 7B. Refusal Letter	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 3 Questionnair for Telephone Interview.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,870

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,870	2,870
Annual IC Time Burden (Hours)	861	861
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 6 Advance Letter	Attachment 6 Advance Letter.doc	11/28/2007
Attachment 7A. Non-Contact Letter	Attachment 7A Non-Contact Letter.doc	11/28/2007
Attachment 7B. Refusal Letter	Attachment 7B Refusal Letter.doc	11/28/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.