Question Guide for Face-to-Face Evaluation Interviews

[NCEZID] School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out

Documents and Forms

Document Name Document Type
Form 0920-22HN Question Guide for Face-to-Face Evaluation Interviews Form and Instruction
0920-22HN Question Guide for Face-to-Face Evaluation Interviews Attachment E_SBAS_Question Guide for Face to Face Evaluation Interviews.docx Form and Instruction
0920-22HN Question Guide for Face-to-Face Evaluation Interviews Attachment E_SBAS_Question Guide for Face to Face Evaluation Interviews.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Question Guide for Face-to-Face Evaluation Interviews	Agency IC Tracking Number:	0920-22HN

Is this a Common Form? Yes		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	0920-22HN	Question Guide for Face-to-Face Evaluation Interviews	Attachment E_SBAS_Question Guide for Face to Face Evaluation Interviews.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.