Information Collection

PATH/Baseline- Adults-Followup/Tracking Participant Information Form

IC 203760 under ICR 201307-0925-001 · OMB 0925-0664.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0664 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 PATH/Baseline- Adults-Followup/Tracking Participant Information Form	Form and Instruction
1 Follow-up/Tracking Participant Information Form 3f - English. Followup Tracking participant Information Form 050813.pdf	Form and Instruction

IC Title:

PATH/Baseline- Adults-Followup/Tracking Participant Information Form

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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Follow-up/Tracking Participant Information Form	3f - English. Followup Tracking participant Information Form 050813.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: NIH Privacy Act System of Records 09-25-0200 Clinical, Basic Population-based research studies of NIH, HHS/NIH/OD

FR Citation: 67 FR 60741

Number of Respondents: 42,730

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	85,460	0	85,460
Annual IC Time Burden (Hours)	11,395	2,849	8,546
Annual IC Cost Burden (Dollars)	0	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.