Information Collection

Chronic Fatigue Syndrome: Symptoms from the Patient Perspective

IC 217291 under ICR 201407-0920-001 · OMB 0920-1026.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

15ANN

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.