Information Collection

Path Study Data Collection Instruments

IC 222213 under ICR 201606-0925-008 · OMB 0925-0664.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Path Study Data Collection Instruments	Form and Instruction
1 PATH Study Data Collection Instruments Attach2A. PATH Study Data Collection Instruments.pdf	Form and Instruction
2 PATH Study Data Collection Instruments Attach2B. PATH Study Data Collection Instruments.pdf	Form and Instruction
Attach6. Additional Information on Biospecimens.pdf Additional Information on Biospecimens	IC Document
Attach11. Consent Materials.pdf Consent Materials	IC Document
Attach18. Field Data Collection Materials.pdf Field Data Collection Materials	IC Document
Attach9. Follow-up Retention and Tracking Materials.pdf Follow-up Rentention and Tracking Materials	IC Document
Attach4. Summary of Changes to Instruments for Wave 4.pdf Summary of Changes to Instrument for Wave 4	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	PATH Study Data Collection Instruments	Attach2A. PATH Study Data Collection Instruments.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	PATH Study Data Collection Instruments	Attach2B. PATH Study Data Collection Instruments.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH)

FR Citation: 67 FR 187

Number of Respondents: 49,210

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	442,123	442,123
Annual IC Time Burden (Hours)	94,798	94,798
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Additional Information on Biospecimens	Attach6. Additional Information on Biospecimens.pdf	06/27/2016
Consent Materials	Attach11. Consent Materials.pdf	06/27/2016
Field Data Collection Materials	Attach18. Field Data Collection Materials.pdf	06/27/2016
Follow-up Rentention and Tracking Materials	Attach9. Follow-up Retention and Tracking Materials.pdf	06/27/2016
Summary of Changes to Instrument for Wave 4	Attach4. Summary of Changes to Instruments for Wave 4.pdf	06/29/2016

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