Formative Research to Support Active Surveillance of Myalgic Encelphalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren

CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 243850

Documents and Forms
Document Name
Document Type
Form
Other-Question Guide
Form
Form
Form
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Formative Research to Support Active Surveillance of Myalgic Encelphalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren 0920-1154-20OB
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none School District Feedback Form Attachment F -School Surveillance GenIC--School District Feedback Form.docx Yes Yes Fillable Fileable
Form none Electronic Platform Chronic Absenteeism Reporting Form Attachment A -School Surveillance GenIC--Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form.docx Yes Yes Fillable Fileable
Form none Demographic Data Collection Points Attachment B - School Surveillance GenIC-- Demographic Data Collection Points.docx Yes Yes Fillable Fileable
Form none Pilot Site Baseline Survey Attachment C -School Surveillance GenIC-- Pilot Site Baseline Survey.docx Yes Yes Fillable Fileable
Form none Webinar Feedback Form Attachment D-School Surveillance GenIC-- Webinar 1 Feedback Form.docx Yes Yes Fillable Fileable
Other-Question Guide Attachment E -School Surveillance GenIC--Question Guide for Face to Face Evaluation Interviews.docx Yes No Paper Only

Health Public Health Monitoring

 

80 0
   
State, Local, and Tribal Governments
 
   88 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 116 0 116 0 0 0
Annual IC Time Burden (Hours) 228 0 228 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A Supporting Statement A Active Surveillance School Age Children Pilot rev_08.19.20_clean.docx 10/01/2020
Supporting Statement B Supporting Statement B Active Surveillance School Age Children Pilot rev_08.19.20_clean.docx 10/01/2020
Request for Approval GenIC Request Template for Active Surveillance of School Age Children Pilot.docx 10/01/2020
IRB Approval Attachment H -School Surveillance GenIC--IRB Protocol Approval with Modifications.pdf 10/01/2020
Consent - School district representatives Attachment I -School Surveillance GenIC--Consent Form and Authorization for School District Representatives.docx 10/01/2020
Consent - School nurses Attachment J -School Surveillance GenIC--Consent Form and Authorization for School Nurses.docx 10/01/2020
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