Information Collection Request

Medical Monitoring Project

ICR 202101-0920-006 · OMB 0920-0740 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Recruitment Form and Instruction Modified Available
2021 Questionnaire Form and Instruction Modified Missing upstream
Att 17 SampleSizes.docx Supplementary Document Uploaded 2021-01-13 Repair queued
Att 16 Agreement To Abide by Restrictions.docx Supplementary Document Uploaded 2021-01-13 Available
Att 15 2018 DCC ATO.pdf Supplementary Document Uploaded 2021-01-13 Missing upstream
Att 14 MMP project determination.pdf Supplementary Document Uploaded 2021-01-13 Missing upstream
Att 13 Assurance of Confidentiality.docx Supplementary Document Uploaded 2021-01-13 Repair queued
Att 12_PrivacyImpactAssessment 2020 11 30.pdf Supplementary Document Uploaded 2021-01-13 Repair queued
Att 11 Consultations Conducted Before 2010.docx Supplementary Document Uploaded 2021-01-13 Repair queued
Att 10 MMP Bibliography 2020_07_18.rtf Supplementary Document Uploaded 2021-01-13 Missing upstream
Att 9 MMP_CrossJuris_Agreement_MMP 2020_Cycle.docx Supplementary Document Uploaded 2021-01-13 Missing upstream
Att 8d Recruitment Text E-mail.docx Supplementary Document Uploaded 2021-01-13 Repair queued
Att 7 References.docx Supplementary Document Uploaded 2021-01-13 Available
Att 6 MMP MRA Data Structure 2020 06 15.docx Supplementary Document Uploaded 2021-01-13 Repair queued
Att 5d Summary of changes to questionnaire.docx Supplementary Document Uploaded 2021-01-13 Repair queued
Att 4 MMP Minimum Dataset Elements.docx Supplementary Document Uploaded 2021-01-13 Repair queued
Att 3b MMP Model Consent 2018.docx Supplementary Document Uploaded 2021-01-13 Repair queued
Att 3a MMP 2021-2023 Model Consent.docx Supplementary Document Uploaded 2021-01-13 Repair queued
Att 2_60-Day FRN.pdf Supplementary Document Uploaded 2021-01-13 Missing upstream
Att 1_Sect 301 PHSA.PDF Supplementary Document Uploaded 2021-01-13 Repair queued
MMP-SSB_2020 12 01 clean.docx Supporting Statement B Uploaded 2021-01-13 Repair queued
MMP-SSA_2021-01-11.docx Supporting Statement A Uploaded 2021-01-13 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
180569 Pull medical records Instruction Modified
180568 Contact information look-up Instruction Modified
180566 Recruitment Form and Instruction Modified
180565 2021 Questionnaire Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 06/30/2021
18,430 18,430
5,707 6,354
147,364 140,018





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
2021 Questionnaire none, none MMP Questionnaire 2021 - English ,   MMP Questionnaire - Spanish
Contact information look-up
Pull medical records
Recruitment none Recruitment script

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 18,430 18,430 0 0 0 0
Annual Time Burden (Hours) 5,707 6,354 0 -647 0 0
Annual Cost Burden (Dollars) 147,364 140,018 0 7,346 0 0


Reginfo record details
  No