Home Monitoring for Early Detection of Chronic Disease Exacerbation (COPD)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Document Name Document Type
Ball-VINYA-Interview Guide_Veteran COPD_May 2019.pdf Other-Interview Guide
SF36 Tosonly_Quality of Life Survey_Veteran COPD_May 2019.pdf Other-Survey
St Georges Respiratory Questionnaire_Veteran COPD_May 2019.pdf Other-Questionnaire
PHQ- 8_Veteran COPD_May 2019.pdf Other-Questionnaire
Ball-VINYA-Interview guide-Veteran_OMB passback rev3_07162019.pdf Other-Interview Guide
St Georges resp questionnaire_OMB passback rev3_07162019.pdf Other-Questionnaire
PHQ- 8_OMB passback rev3_07162019.pdf Other-Questionnaire
SF36 tosonly QoLife survey_OMB passback rev3_07162019.pdf Other-Survey
COPD Home Sensors_Interview-Survey_Generic Statement_Final.doc COPD Home Sensors Interview-Survey_Generic Statement_Final IC Document

Information Collection (IC) Details

IC Title:	Home Monitoring for Early Detection of Chronic Disease Exacerbation (COPD)	Agency IC Tracking Number:	2900-0770

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Questionnaire	St Georges resp questionnaire_OMB passback rev3_07162019.pdf	No	Paper Only
Other-Interview Guide	Ball-VINYA-Interview guide-Veteran_OMB passback rev3_07162019.pdf	No	Paper Only
Other-Questionnaire	PHQ- 8_OMB passback rev3_07162019.pdf	No	Paper Only
Other-Survey	SF36 tosonly QoLife survey_OMB passback rev3_07162019.pdf	No	Paper Only
Other-Interview Guide	Ball-VINYA-Interview Guide_Veteran COPD_May 2019.pdf	No	Paper Only
Other-Survey	SF36 Tosonly_Quality of Life Survey_Veteran COPD_May 2019.pdf	No	Paper Only
Other-Questionnaire	St Georges Respiratory Questionnaire_Veteran COPD_May 2019.pdf	No	Paper Only
Other-Questionnaire	PHQ- 8_Veteran COPD_May 2019.pdf	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	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	25	25
Annual IC Time Burden (Hours)	46	46
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
COPD Home Sensors Interview-Survey_Generic Statement_Final	COPD Home Sensors_Interview-Survey_Generic Statement_Final.doc	06/10/2019

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