Information Collection

Survey of past participants of the National Institute of Neurological Disorders and Stroke (NINDS) Anticonvulsant Screening Program (ASP)

IC 213576 under ICR 201307-0925-006 · OMB 0925-0678.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Survey of past participants of the National Institute of Neurological Disorders and Stroke (NINDS) Anticonvulsant Screening Program (ASP)	Form and Instruction
1 ASP Survey Screenshot ASPparticipantsurvey_screenshots2.pdf	Form and Instruction
fast-track-template-short-form_ASP.docx ASP Fast-Track Template	IC Document
ASP survey_email and other text2.docx ASP email	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

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	ASP Survey Screenshot	ASPparticipantsurvey_screenshots2.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 142

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	142	142
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ASP Fast-Track Template	fast-track-template-short-form_ASP.docx	10/22/2014
ASP email	ASP survey_email and other text2.docx	10/22/2014

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