Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire - Pre-Intervention

Registry of Unexplained Fatiguing Illnesses and Chronic Fatigue Syndrome (CFS): A Pilot Study

Documents and Forms

Document Name Document Type
Form No number Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire - Pre-Intervention Form and Instruction
No number Provider Questionnaire - Pre-intervention Attachment 6b Provider Questionnaire (Knowledge Attitues Beliefs) Pre-intervention.doc Form and Instruction
Attachment 6a Non-physician referral instructions.doc Attachment 6a Non-physician referral instructions IC Document
Attachment 6a Physician Referral Instructions.doc Attachment 6a Physician Referral Instructions IC Document

Information Collection (IC) Details

IC Title:	Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire - Pre-Intervention	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form and Instruction	No number	Provider Questionnaire - Pre-intervention	Attachment 6b Provider Questionnaire (Knowledge Attitues Beliefs) Pre-intervention.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 466	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	466	466
Annual IC Time Burden (Hours)	62	62
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 6a Non-physician referral instructions	Attachment 6a Non-physician referral instructions.doc	12/19/2007
Attachment 6a Physician Referral Instructions	Attachment 6a Physician Referral Instructions.doc	12/19/2007

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