Medical Outcomes Study Short Form

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

Documents and Forms

Document Name Document Type
Form No number Medical Outcomes Study Short Form Form
No number Medical Outcomes Study Short Form Attachment 22 Medical Outcomes Study Short Form 36.pdf Form
Attachment 22 Multi-dimensional Fatigue Inventory OMB cover sheet.doc Medical Outcomes Study Short Form - Coverpage IC Document

Information Collection (IC) Details

IC Title:	Medical Outcomes Study Short Form	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	No number	Medical Outcomes Study Short Form	Attachment 22 Medical Outcomes Study Short Form 36.pdf		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: 246	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	246	246
Annual IC Time Burden (Hours)	82	82
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Medical Outcomes Study Short Form - Coverpage	Attachment 22 Multi-dimensional Fatigue Inventory OMB cover sheet.doc	12/19/2007

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