Information Collection

Instruments for Wave 3 of the PATH Study

IC 212557 under ICR 201606-0925-008 · OMB 0925-0664.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1-Rev Instruments for Wave 3 of the PATH Study	Form and Instruction
1-Rev PATH Data Collection Instruments for Wave 3 English and 2 PATH Study Data Collection Instruments.pdf	Form and Instruction
2 Follow up, Retention and Tracking Documents - English Ve 9 Followup, Retention, and Tracking Materials.pdf	Form and Instruction
3-New PATH Verification Form 23_PATH Verification Form (new) 5-8-15.pdf	Form and Instruction
3-New PATH Validation Form 24_PATH Validation Form (new) 5-8-15.pdf	Form and Instruction
5 Summary of Changes to PATH Study Instruments.pdf Summary of Changes to the Instrument for Wave 3	IC Document
6 Additional Information on Biospecimens.pdf Additional Biospecimen Information for Wave 3	IC Document
19 Field Data Collection Materials.pdf Field Materials - English and Spanish for Wave 3	IC Document
17 Procedures for Keeping Data Confidential.pdf Data Confidentially Procedures for Wave 3	IC Document
18 ICPSR Data Use Agreement.pdf Data Use Agreement for Wave 3	IC Document
8 Key Design Features.pdf Key Survey Design Features for Wave 3	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1-Rev	PATH Data Collection Instruments for Wave 3 English and Spanish Versions	2 PATH Study Data Collection Instruments.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	Follow up, Retention and Tracking Documents - English Version	9 Followup, Retention, and Tracking Materials.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3-New	PATH Verification Form	23_PATH Verification Form (new) 5-8-15.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3-New	PATH Validation Form	24_PATH Validation Form (new) 5-8-15.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-25-0200 Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH), HHSAIIH/OD

FR Citation: 67 FR 60741

Number of Respondents: 41,662

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-192,858	192,858
Annual IC Time Burden (Hours)	-54,434	54,434
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Summary of Changes to the Instrument for Wave 3	5 Summary of Changes to PATH Study Instruments.pdf	06/19/2015
Additional Biospecimen Information for Wave 3	6 Additional Information on Biospecimens.pdf	06/19/2015
Field Materials - English and Spanish for Wave 3	19 Field Data Collection Materials.pdf	06/19/2015
Data Confidentially Procedures for Wave 3	17 Procedures for Keeping Data Confidential.pdf	06/19/2015
Data Use Agreement for Wave 3	18 ICPSR Data Use Agreement.pdf	06/19/2015
Key Survey Design Features for Wave 3	8 Key Design Features.pdf	06/19/2015

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