Information Collection

Feasibility Study for a MEPS Monthly Check-In

IC 251475 under ICR 202401-0935-006 · OMB 0935-0124.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1B Feasibility Study for a MEPS Monthly Check-In	Form and Instruction
2F - Study 2 FG Guide.docx	Instruction
2F - Study 2 FG Guide.docx	Instruction
1A Study 1 Ad.docx	Instruction
1A Study 1 Ad.docx	Instruction
1B Attachment 1-B. Study 1 Recruitment screener 1B Study 1 Recruitment Screener.docx	Form and Instruction
1B Attachment 1-B. Study 1 Recruitment screener 1B Study 1 Recruitment Screener.docx	Form and Instruction
1C Attachment 1-B. Study 1 Recruitment screener 1C Study 1 Recruitment Script.docx	Form and Instruction
1C Attachment 1-B. Study 1 Recruitment screener 1C Study 1 Recruitment Script.docx	Form and Instruction
1F Attachment 1-F. Study 1 MCI Protocol 1 1F Study 1 Protocol 1 (MCI-1).docx	Form and Instruction
1F Attachment 1-F. Study 1 MCI Protocol 1 1F Study 1 Protocol 1 (MCI-1).docx	Form and Instruction
1G Attachment 1-G. Study 1 MCI Protocol 2 1G Study 1 Protocol 2 (MCI-2).docx	Form and Instruction
1G Attachment 1-G. Study 1 MCI Protocol 2 1G Study 1 Protocol 2 (MCI-2).docx	Form and Instruction
1H Attachment 1-H. Study 1 Protocol 3 (R2) 1H Study 1 Protocol 3 (R2).docx	Form and Instruction
1H Attachment 1-H. Study 1 Protocol 3 (R2) 1H Study 1 Protocol 3 (R2).docx	Form and Instruction
1I Attachment 1-I. Study 1 MEPS Abbreviated R2 Interview 1I Study 1 R2_instrument.docx	Form and Instruction
1I Attachment 1-I. Study 1 MEPS Abbreviated R2 Interview 1I Study 1 R2_instrument.docx	Form and Instruction
2B Attachment 2-B. Study 2 Recruitment telephone script + s 2B - Study 2 Recruitment Script.docx	Form and Instruction
2B Attachment 2-B. Study 2 Recruitment telephone script + s 2B - Study 2 Recruitment Script.docx	Form and Instruction
2E Attachment 2-E. Study 2 MCI Protocol 2E - Study 2 MCI Protocol.docx	Form and Instruction
2E Attachment 2-E. Study 2 MCI Protocol 2E - Study 2 MCI Protocol.docx	Form and Instruction
OMB Cover Letter.docx Cover Letter	IC Document
OMB Cover Letter.docx Cover Letter	IC Document
1D Study 1 Informed Consent.docx Attachment 1-D. Study 1 Consent form	IC Document
1D Study 1 Informed Consent.docx Attachment 1-D. Study 1 Consent form	IC Document
1E Study 1 Zoom_instructions.docx Attachment 1-E. Study 1 Zoom instructions	IC Document
1E Study 1 Zoom_instructions.docx Attachment 1-E. Study 1 Zoom instructions	IC Document
2A - Study 2 Recruitment Letter.docx Attachment 2-A. Study 2 Recruitment letter	IC Document
2A - Study 2 Recruitment Letter.docx Attachment 2-A. Study 2 Recruitment letter	IC Document
2C - Study 2 InformedConsent.docx Attachment 2-C. Study 2 Consent form	IC Document
2C - Study 2 InformedConsent.docx Attachment 2-C. Study 2 Consent form	IC Document
2D - Study 2 Zoom_instructions.docx Attachment 2-D. Study 2 Zoom instructions	IC Document
2D - Study 2 Zoom_instructions.docx Attachment 2-D. Study 2 Zoom instructions	IC Document
MCI Statement A.docx Supporting Statement Part A	IC Document
MCI Statement A.docx Supporting Statement Part A	IC Document
MCI Statement B_OMB_updated.docx Supporting Statement Part B	IC Document
MCI Statement B_OMB_updated.docx Supporting Statement Part B	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Feasibility Study for a MEPS Monthly Check-In

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1B	Attachment 1-B. Study 1 Recruitment screener	1B Study 1 Recruitment Screener.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1C	Attachment 1-B. Study 1 Recruitment screener	1C Study 1 Recruitment Script.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1F	Attachment 1-F. Study 1 MCI Protocol 1	1F Study 1 Protocol 1 (MCI-1).docx	Yes	Yes	Fillable Fileable
Form and Instruction	1G	Attachment 1-G. Study 1 MCI Protocol 2	1G Study 1 Protocol 2 (MCI-2).docx	Yes	Yes	Fillable Fileable
Form and Instruction	1H	Attachment 1-H. Study 1 Protocol 3 (R2)	1H Study 1 Protocol 3 (R2).docx	Yes	Yes	Fillable Fileable
Form and Instruction	1I	Attachment 1-I. Study 1 MEPS Abbreviated R2 Interview	1I Study 1 R2_instrument.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2B	Attachment 2-B. Study 2 Recruitment telephone script + scheduling MCI interview	2B - Study 2 Recruitment Script.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2E	Attachment 2-E. Study 2 MCI Protocol	2E - Study 2 MCI Protocol.docx	Yes	Yes	Fillable Fileable
Instruction			2F - Study 2 FG Guide.docx	No		Paper Only
Instruction			1A Study 1 Ad.docx	No		Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 195

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	195	195
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Letter	OMB Cover Letter.docx	02/11/2022
Attachment 1-D. Study 1 Consent form	1D Study 1 Informed Consent.docx	03/07/2022
Attachment 1-E. Study 1 Zoom instructions	1E Study 1 Zoom_instructions.docx	02/11/2022
Attachment 2-A. Study 2 Recruitment letter	2A - Study 2 Recruitment Letter.docx	03/07/2022
Attachment 2-C. Study 2 Consent form	2C - Study 2 InformedConsent.docx	03/07/2022
Attachment 2-D. Study 2 Zoom instructions	2D - Study 2 Zoom_instructions.docx	02/11/2022
Supporting Statement Part A	MCI Statement A.docx	02/11/2022
Supporting Statement Part B	MCI Statement B_OMB_updated.docx	03/07/2022

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