Information Collection

Clinic Visit 2

IC 203352 under ICR 201301-0925-001 · OMB 0925-0671.

Documents and Forms

Document Name Document Type
Form 3.1 Clinic Visit 2 Form and Instruction
3.1 Survey Attach 9. Visit 2 Stress Questionnaire.docx Form and Instruction
Attach 16. Study Visit 2 Blood Requisition Form.docx Attach 16. Study Visit 2 Blood Requisition Form IC Document
Attach 18. Visit 2 Blood Processing Protocol.docx Attach 18. Visit 2 Blood Processing Protocol IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Clinic Visit 2	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	3.1	Survey	Attach 9. Visit 2 Stress Questionnaire.docx		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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	233	233
Annual IC Time Burden (Hours)	408	408
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attach 16. Study Visit 2 Blood Requisition Form	Attach 16. Study Visit 2 Blood Requisition Form.docx	12/06/2012
Attach 18. Visit 2 Blood Processing Protocol	Attach 18. Visit 2 Blood Processing Protocol.docx	12/06/2012

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