Chronic Fatigue Syndrome: Symptoms from the Patient Perspective

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

Documents and Forms

Document Name Document Type
Attachment 1 CFS Patient Perspective Focus Group Guide 6112015.docx Other-WORD
Attachment 2 CFS Patient Perspective Interview Guide 6112015.docx Other-WORD
Attachment 5 CFS Patient Perspective Focus Group Screener 6_10_15 corrected.doc Other-WORD
Attachment 3 CFS Patient Perspective Recruitment Focus Group Flyer 062615.pdf Att 3 Focus Group Recruitment Flyer IC Document
Attachment 4 CFS Patient Perspective Recruitment Interview Flyer 062615.pdf Att 4 Interview Recruitment Flyer IC Document
Attachment 6 CFS Patient Perspective Sampling Plan 6_10_15.docx Att 6 Sampling Plan IC Document
Service Delivery_GenIC_Chronic Fatigue Syndrome Patient Perspective_Final 6112015.docx Request for Approval for 0920-15ANN IC Document

Information Collection (IC) Details

IC Title:	Chronic Fatigue Syndrome: Symptoms from the Patient Perspective	Agency IC Tracking Number:	15ANN

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	Attachment 1 CFS Patient Perspective Focus Group Guide 6112015.docx	No	Paper Only
Other-WORD	Attachment 2 CFS Patient Perspective Interview Guide 6112015.docx	No	Paper Only
Other-WORD	Attachment 5 CFS Patient Perspective Focus Group Screener 6_10_15 corrected.doc	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 102	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	102	102
Annual IC Time Burden (Hours)	99	99
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 3 Focus Group Recruitment Flyer	Attachment 3 CFS Patient Perspective Recruitment Focus Group Flyer 062615.pdf	06/30/2015
Att 4 Interview Recruitment Flyer	Attachment 4 CFS Patient Perspective Recruitment Interview Flyer 062615.pdf	06/30/2015
Att 6 Sampling Plan	Attachment 6 CFS Patient Perspective Sampling Plan 6_10_15.docx	06/30/2015
Request for Approval for 0920-15ANN	Service Delivery_GenIC_Chronic Fatigue Syndrome Patient Perspective_Final 6112015.docx	06/30/2015

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