OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Multi-site Clinical Assessment of Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (MCAM)ATT.5

IC 248257 under ICR 202106-0920-021 · OMB 0920-1341.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 0920-20QS
Multi-site Clinical Assessment of Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (MCAM)ATT.5		 Form and Instruction
0920-20QS 1_Visual Analogue Scale for CFS Symptoms
1_Visual Analogue Scale for CFS Symptoms.pdf 		Form and Instruction
0920-20QS 1_Visual Analogue Scale for CFS Symptoms
1_Visual Analogue Scale for CFS Symptoms.pdf 		Form and Instruction
0920-20QS 2_EQ-5D-Y Health Questionnaire
2_EQ-5D-Y Health Questionnaire.pdf 		Form and Instruction
0920-20QS 2_EQ-5D-Y Health Questionnaire
2_EQ-5D-Y Health Questionnaire.pdf 		Form and Instruction
0920-20QS 3_PROMIS SFv1 Physical Function
3_PROMIS SFv1 Physical Function.pdf 		Form and Instruction
0920-20QS 3_PROMIS SFv1 Physical Function
3_PROMIS SFv1 Physical Function.pdf 		Form and Instruction
0920-20QS 4_Physical Fitness and Exercise Activity Levels of Scale
4_Physical Fitness and Exercise Activity Levels of Scale.pdf 		Form and Instruction
0920-20QS 4_Physical Fitness and Exercise Activity Levels of Scale
4_Physical Fitness and Exercise Activity Levels of Scale.pdf 		Form and Instruction
0920-20QS 5_International Physical Activity Questionnaire_Self-Adm
5_International Physical Activity Questionnaire_Self-Administered Long Form.pdf 		Form and Instruction
0920-20QS 5_International Physical Activity Questionnaire_Self-Adm
5_International Physical Activity Questionnaire_Self-Administered Long Form.pdf 		Form and Instruction
0920-20QS 6_Physical Activity Readiness Questionnaire_PAR-Q
6_Physical Activity Readiness Questionnaire_PAR-Q.pdf 		Form and Instruction
0920-20QS 6_Physical Activity Readiness Questionnaire_PAR-Q
6_Physical Activity Readiness Questionnaire_PAR-Q.pdf 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 0920-20QS 1_Visual Analogue Scale for CFS Symptoms 1_Visual Analogue Scale for CFS Symptoms.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 2_EQ-5D-Y Health Questionnaire 2_EQ-5D-Y Health Questionnaire.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 3_PROMIS SFv1 Physical Function 3_PROMIS SFv1 Physical Function.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 4_Physical Fitness and Exercise Activity Levels of Scale 4_Physical Fitness and Exercise Activity Levels of Scale.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 5_International Physical Activity Questionnaire_Self-Administered Long Form 5_International Physical Activity Questionnaire_Self-Administered Long Form.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20QS 6_Physical Activity Readiness Questionnaire_PAR-Q 6_Physical Activity Readiness Questionnaire_PAR-Q.pdf Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 294 0 0 0 294 0
Annual IC Time Burden (Hours) 291 0 0 0 291 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.