Health Education and Health Promotion in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Knowledge, Attitudes and Beliefs in the U.S. General Public

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Health Education and Health Promotion in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Knowledge, Attitudes and Beliefs in the U.S. General Public Form and Instruction
Screener 5_Attachment2__HEHP_MECFS_KAB_Pilot_Screener_20201029.docx Form and Instruction
Survey 6_Attachment3__HEHP_MECFS_KAB_Pilot_Survey_20201123.docx Form and Instruction
3_GenICRequest_HEHP_MECFS_KAB_Pilot_20201201.docx GENIC Template with Project Description IC Document
1_SSA_HEHP_MECFS_KAB_Pilot_20201201.docx Supporting Statement A: Justification IC Document
2_SSB_HEHP_MECFS_KAB_Pilot_20201123.docx Supporting Statement B: Statistical Methods IC Document
4_Attachment1__HEHP_MECFS_KAB_Pilot_Invitation.docx Invitation to Potential Participants IC Document
7_Attachment4_Human_Subjects_Review.pdf Human Subjects Determination: IRB Approval Not Required IC Document

Information Collection (IC) Details

IC Title:	Health Education and Health Promotion in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Knowledge, Attitudes and Beliefs in the U.S. General Public	Agency IC Tracking Number:	0920-21AS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Screener	5_Attachment2__HEHP_MECFS_KAB_Pilot_Screener_20201029.docx		Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Survey	6_Attachment3__HEHP_MECFS_KAB_Pilot_Survey_20201123.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,800	3,800
Annual IC Time Burden (Hours)	530	530
Annual IC Cost Burden (Dollars)	13,249	13,249

Documents for IC

Title	Document	Date Uploaded
GENIC Template with Project Description	3_GenICRequest_HEHP_MECFS_KAB_Pilot_20201201.docx	12/01/2020
Supporting Statement A: Justification	1_SSA_HEHP_MECFS_KAB_Pilot_20201201.docx	12/01/2020
Supporting Statement B: Statistical Methods	2_SSB_HEHP_MECFS_KAB_Pilot_20201123.docx	12/01/2020
Invitation to Potential Participants	4_Attachment1__HEHP_MECFS_KAB_Pilot_Invitation.docx	12/01/2020
Human Subjects Determination: IRB Approval Not Required	7_Attachment4_Human_Subjects_Review.pdf	12/01/2020

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