Information Collection

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

IC 244720 under ICR 201912-0920-003 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screener 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
Survey 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

View Information Collection (IC)

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:

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	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

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	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

table that charts IC Documents
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.