Information Collection

Neuro-QOL Form

IC 184026 under ICR 200803-0925-001 · OMB 0925-0592.

Documents and Forms

Document Name Document Type
Form 1 Neuro-QOL Form Form and Instruction
1 Survey APPENDIX 1 NEURO-QOL OMB.doc Form and Instruction
2 Survey-Excel APPENDIX 2 NEURO-QOL OMB.xls Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Neuro-QOL 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 and Instruction	1	Survey	APPENDIX 1 NEURO-QOL OMB.doc		Yes	Yes	Paper Only
Form and Instruction	2	Survey-Excel	APPENDIX 2 NEURO-QOL OMB.xls		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,000	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	9,000	9,000
Annual IC Time Burden (Hours)	4,500	4,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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