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Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) Healthcare Provider Perspective Interview
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0920-1071
IC ID: 229050
OMB.report
HHS/CDC
OMB 0920-1071
ICR 201503-0920-011
IC 229050
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:
2024-05-08 - Revision of a currently approved collection
2024-03-22 - No material or nonsubstantive change to a currently approved collection
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
View Information Collection (IC)
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?
Can Be Submitted 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
Federal Enterprise Architecture Business Reference Module
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 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
70
0
70
0
0
0
Annual IC Time Burden (Hours)
23
0
23
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.