Information Collection

Ambulatory Assessment Period

IC 203351 under ICR 201301-0925-001 · OMB 0925-0671.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2.1 Attach 8. Take Home Packet Ambulatory Assessment Period	Form and Instruction
Attach 19. Saliva Collection Participants Manual.docx	Instruction
Attach 21. Saliva Specimen Log.doc	Other-Log
Attach 22. Electronic Diary Coordinators Manual.doc	Instruction
Attach 23. Actiheart Procedures Coordinators Manual.doc	Instruction
2.1 Attach 8. Take Home Packet Attach 8. Take Home Packet.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	Yes	Paper Only
Other-Log		Yes	Yes	Paper Only
Instruction		Yes	Yes	Paper Only
Instruction		Yes	Yes	Paper Only
Form and Instruction	2.1	Yes	Yes	Paper Only

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 233

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	233	233
Annual IC Time Burden (Hours)	1,068	1,068
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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