OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Multi-site Clinical Assessment of Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (MCAM) ATT.4

IC 248256 under ICR 202106-0920-021 · OMB 0920-1341.

Documents and Forms
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Document Type
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Information Collection (IC) Details

View Information Collection (IC)

Multi-site Clinical Assessment of Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (MCAM) ATT.4 0920-20QS
 
Yes New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 092-20QS 1_CDC Symptom Inventory_For Baseline Subjects Pediatrics 1_CDC Symptom Inventory_For Baseline Subjects Pediatrics.pdf Yes Yes Fillable Fileable
Form and Instruction 920-20QS 2_CDC Symptom Inventory_For the Follow-Up Subjects Pediatrics 2_CDC Symptom Inventory_For the Follow-Up Subjects Pediatrics.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 3_SF-36 Health Survey 3_SF-36 Health Survey.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 4_Multidimensional Fatigue Inventory_MFI-20 4_Multidimensional Fatigue Inventory_MFI-20.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 5_Selected Questions from DePaul Pediatric Health Questionnaire_DPHQ 5_Selected Questions from DePaul Pediatric Health Questionnaire_DPHQ.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 6_PROMIS Pediatric Instruments 6_PROMIS Pediatric Instruments.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 7_Pediatric Pain Questionnaire_PPQ 7_Pediatric Pain Questionnaire_PPQ.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 8_Visual Analogue Scale 8_Visual Analogue Scale.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 9_Hospital Anxiety and Depression Scale 9_Hospital Anxiety and Depression Scale.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 10_Pediatric Daytime Sleepiness Scale 10_Pediatric Daytime Sleepiness Scale.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 11_Social Participation Form Pediatric 11_Social Participation Form Pediatric.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 12_Sociability Form 12_Sociability Form.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 13_Saliva Data Collection Sheet 13_Saliva Data Collection Sheet.pdf Yes Yes Fillable Fileable

Health Illness Prevention

 

808 0
   
Individuals or Households
 
   0 %

  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 808 0 0 0 808 0
Annual IC Time Burden (Hours) 65 0 0 0 65 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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