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Individuals
Recruitment and Screening for the Insight into Determination of Exceptional Aging and Longevity (IDEAL) Study (NIA)
OMB: 0925-0631
IC ID: 195897
OMB.report
HHS/NIH
OMB 0925-0631
ICR 201101-0925-002
IC 195897
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0631 can be found here:
2014-08-19 - Reinstatement with change of a previously approved collection
2011-02-04 - New collection (Request for a new OMB Control Number)
Documents and Forms
Document Name
Document Type
Form 1
Individuals
Form and Instruction
1 Telephone Interview
Attachment 4-Telephone Interview v5 (2578 - Activated Traditional).pdf
Form and Instruction
2 Physical Exam
Attachment 7-PhysicalExam v3 (59451- Activated Traditional).pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Individuals
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
Telephone Interview
Attachment 4-Telephone Interview v5 (2578 - Activated Traditional).pdf
Yes
Yes
Paper Only
Form and Instruction
2
Physical Exam
Attachment 7-PhysicalExam v3 (59451- Activated Traditional).pdf
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
1,500
0
1,500
0
0
0
Annual IC Time Burden (Hours)
701
0
701
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.