Information Collection

Traumatic Brain Injury, Post-traumatic Stress Disorder, and Long-term Quality of Life Outcomes in Injured Tri-service U.S. Military Personnel

IC 203007 under ICR 201207-0720-007 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Baseline Survey.pdf	Other-Baseline Survey
CES.pdf	Other-CES
MUSC.pdf	Other-MUSC
PCL-C.pdf	Other-PCL-C
QWB-SA.pdf	Other-QWB-SA
IRB Approval.pdf IRB Approval	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Baseline Survey	Baseline Survey.pdf	Yes	Yes	Fillable Fileable
Other-CES	CES.pdf	Yes	Yes	Fillable Fileable
Other-MUSC	MUSC.pdf	Yes	Yes	Fillable Fileable
Other-PCL-C	PCL-C.pdf	Yes	Yes	Fillable Fileable
Other-QWB-SA	QWB-SA.pdf	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,644

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,288	9,288
Annual IC Time Burden (Hours)	3,096	3,096
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
IRB Approval	IRB Approval.pdf	07/05/2012

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