MD STARnet Men Living with Muscular Dystrophy Survey

[NCBDDD] The Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet) Living with Muscular Dystrophy Survey

Documents and Forms

Document Name Document Type
MD STARnet Men Living with Muscular Dystrophy Survey Form and Instruction
Men Living with Muscular Dystrophy Survey (paper) Attachment C_MD STARnet Men Living with MD Survey.docx Form and Instruction
Men Living with Muscular Dystrophy Survey (paper) Attachment C_MD STARnet Men Living with MD Survey.docx Form and Instruction
Men Living with Muscular Dystrophy Survey (screen shot o Attachment C-2_Introduction to Men's Web-based Survey.docx Form and Instruction
Men Living with Muscular Dystrophy Survey (screen shot o Attachment C-2_Introduction to Men's Web-based Survey.docx Form and Instruction
Men Living with Muscular Dystrophy Survey (telephone int 2023 2 13 Attachment E_MD STARnet Men Living with MD Phone Script.docx Form and Instruction
Men Living with Muscular Dystrophy Survey (telephone int 2023 2 13 Attachment E_MD STARnet Men Living with MD Phone Script.docx Form and Instruction

Information Collection (IC) Details

IC Title:	MD STARnet Men Living with Muscular Dystrophy Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Men Living with Muscular Dystrophy Survey (paper)	Attachment C_MD STARnet Men Living with MD Survey.docx	No		Paper Only
Form and Instruction	None	Men Living with Muscular Dystrophy Survey (screen shot of intro to the web-based form)	Attachment C-2_Introduction to Men's Web-based Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	None	Men Living with Muscular Dystrophy Survey (telephone interview)	2023 2 13 Attachment E_MD STARnet Men Living with MD Phone Script.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 538	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 60 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	538	538
Annual IC Time Burden (Hours)	135	135
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.