Information Collection

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

IC 229050 under ICR 201503-0920-011 · OMB 0920-1071.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.