OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Clinical Exam

IC 210241 under ICR 201401-0925-009 · OMB 0925-0626.

Documents and Forms
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Form
Instruction
Instruction
Instruction
Form
Form
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Clinical Exam
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 2 Clinical Exam Saliva Collection Log Att26 Clinic Exam Saliva Collection Log 12052013.pdf Yes Yes Fillable Fileable
Form 3 Clinical Exam Questioniare Att27 Clinic Exam Questionnaire_12042013.pdf Yes Yes Fillable Fileable
Form 4 Clinical Exam Mental Health Questionnaire Att28 Clinic Exam Mental Health Questionnaire_12042013.pdf Yes Yes Fillable Fileable
Instruction Att_15 Clinic Exam Visit Instructions.pdf No No Paper Only
Instruction Att_25 Clinic Exam Saliva Mailing Instructions.pdf No No Paper Only
Instruction Att_24 Clinic Exam Saliva Collection Instructions.pdf No No Paper Only
Form 1 INFORMED CONSENT FORM Att16 Clinic Exam Informed Consent Booklet.pdf Yes Yes Fillable Fileable

General Science and Innovation Scientific and Technological Research and Innovation

 

4,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,000 0 4,000 0 0 0
Annual IC Time Burden (Hours) 16,000 0 16,000 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att_10 Clinic Exam Invitation Letter Att_10 Clinic Exam Invitation Letter.pdf 01/29/2014
Att_11 Clinic Exam Scheduling Script Att_11 Clinic Exam Scheduling Script.pdf 01/29/2014
Att_12 Clinic Exam Visit Confirmation Letter Att_12 Clinic Exam Visit Confirmation Letter.pdf 01/29/2014
Att_13 Clnic Exam Informed Consent Summary Att_13 Clnic Exam Informed Consent Summary.pdf 01/29/2014
Att_14 Clinic Exam Frequently Asked Questions Att_14 Clinic Exam Frequently Asked Questions.pdf 01/29/2014
Att_17 Clinic Exam Blood Pressure Results Form Att_17 Clinic Exam Blood Pressure Results Form.pdf 01/29/2014
Att_18 Clinic Exam Body Mass Index Results Form Att_18 Clinic Exam Body Mass Index Results Form.pdf 01/29/2014
Att_19 Clinic Exam Cholesterol Results Form Att_19 Clinic Exam Cholesterol Results Form.pdf 01/29/2014
Att_20 Clinic Exam Hemoglobin Results Form Att_20 Clinic Exam Hemoglobin Results Form.pdf 01/29/2014
Att_21 Clinic Exam Heart Rate Results Form Att_21 Clinic Exam Heart Rate Results Form.pdf 01/29/2014
Att_22 Clinic Exam Pulmonary Function Result Form Att_22 Clinic Exam Pulmonary Function Result Form.pdf 01/29/2014
Att_23 Clinic Exam Saliva Collection General Instructions Att_23 Clinic Exam Saliva Collection General Instructions.pdf 01/29/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.