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

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NINDS)

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Survey of past participants of the National Institute of Neurological Disorders and Stroke (NINDS) Anticonvulsant Screening Program (ASP)	Agency IC Tracking Number:

IC Status: New

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	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 %

	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

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.