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Follow-up Study of Chronic Fatigue Syndrome in Georgia (Survey of Chronic Fatigue Syndrome & Chronic Unwellness in Georgia-Base Line Survey)
Follow-up Study of Chronic Fatigue Syndrome in Georgia (Survey of Chronic Fatigue Syndrome & Chronic Unwellness in Georgia-Baseline Survey)
OMB: 0920-0638
IC ID: 7106
OMB.report
HHS/CDC
OMB 0920-0638
ICR 200712-0920-006
IC 7106
( )
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Follow-up Study of Chronic Fatigue Syndrome in Georgia (Survey of Chronic Fatigue Syndrome & Chronic Unwellness in Georgia-Base Line Survey)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Instruction
Attachment 3 Questionnair for Telephone Interview.doc
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
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 %
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
2,870
0
2,870
0
0
0
Annual IC Time Burden (Hours)
861
0
861
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.