Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) Healthcare Provider Perspective Interview

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:

Documents and Forms

Document Name Document Type
Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) Healthcare Provider Perspective Interview Form and Instruction
MECFS HP - Screener Appendix 1_MECFS HCP Screener_Final_11_14_17.docx Form and Instruction
MECFS HP - Individual Interview Appendix 2_MECFS HCP Individual Interview Guide_Final_11_14_2017.docx Form and Instruction
MECFS HP - Dyadic Interview Appendix 3_MECFS HCP Dyadic Interview Guide_Final_11_14_2017.doc Form and Instruction
Appendix 4_IRB Exemption.docx IRB Exemption IC Document
Generic Clearance MECFS HCP Perspective Form 20NOV2017.docx GenIC Request IC Document

Information Collection (IC) Details

IC Title:	Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) Healthcare Provider Perspective Interview	Agency IC Tracking Number:	0920-1071-18FP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form and Instruction	NA	MECFS HP - Screener	Appendix 1_MECFS HCP Screener_Final_11_14_17.docx	NA	No	Fillable Printable
Form and Instruction	NA	MECFS HP - Individual Interview	Appendix 2_MECFS HCP Individual Interview Guide_Final_11_14_2017.docx	NA	No	Fillable Printable
Form and Instruction	NA	MECFS HP - Dyadic Interview	Appendix 3_MECFS HCP Dyadic Interview Guide_Final_11_14_2017.doc	NA	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	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	70	70
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IRB Exemption	Appendix 4_IRB Exemption.docx	11/15/2017
GenIC Request	Generic Clearance MECFS HCP Perspective Form 20NOV2017.docx	11/20/2017

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