Follow-up on Missing Information

Attachment P

Missing Information Follow Up Mock Form

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/20xx

Missing Information Follow Up – Mock Form

This is a mock form that represents the follow up calls that will be made to study participants who submit annual or monthly surveys that are incomplete or missing information. Follow up calls will be used to collect missing information from the submitted surveys. The types of missing information to be collected typically include their job information and personal health history such as job history, job information, history of musculoskeletal symptoms prior to the study, and accidents that may have caused any musculoskeletal symptoms.

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).