Information Collection

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

IC 236172 under ICR 201710-2900-001 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.