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
Form 1B Attachment 1-B. Study 1 Recruitment screener Feasibility Study for a MEPS Monthly Check-In	Form and Instruction
Form 1C Attachment 1-B. Study 1 Recruitment screener Feasibility Study for a MEPS Monthly Check-In	Form and Instruction
Form 1F Attachment 1-F. Study 1 MCI Protocol 1 Feasibility Study for a MEPS Monthly Check-In	Form and Instruction
Form 1G Attachment 1-G. Study 1 MCI Protocol 2 Feasibility Study for a MEPS Monthly Check-In	Form and Instruction
Form 1H Attachment 1-H. Study 1 Protocol 3 (R2) Feasibility Study for a MEPS Monthly Check-In	Form and Instruction
Form 1I Attachment 1-I. Study 1 MEPS Abbreviated R2 Interview Feasibility Study for a MEPS Monthly Check-In	Form and Instruction
Form 2B Attachment 2-B. Study 2 Recruitment telephone script + scheduling MCI interview Feasibility Study for a MEPS Monthly Check-In	Form and Instruction
Form 2E Attachment 2-E. Study 2 MCI Protocol 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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1B	Yes	Yes	Fillable Fileable
Form and Instruction	1C	Yes	Yes	Fillable Fileable
Form and Instruction	1F	Yes	Yes	Fillable Fileable
Form and Instruction	1G	Yes	Yes	Fillable Fileable
Form and Instruction	1H	Yes	Yes	Fillable Fileable
Form and Instruction	1I	Yes	Yes	Fillable Fileable
Form and Instruction	2B	Yes	Yes	Fillable Fileable
Form and Instruction	2E	Yes	Yes	Fillable Fileable
Instruction		No		Paper Only
Instruction		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		02/11/2022
Attachment 1-D. Study 1 Consent form		03/07/2022
Attachment 1-E. Study 1 Zoom instructions		02/11/2022
Attachment 2-A. Study 2 Recruitment letter		03/07/2022
Attachment 2-C. Study 2 Consent form		03/07/2022
Attachment 2-D. Study 2 Zoom instructions		02/11/2022
Supporting Statement Part A		02/11/2022
Supporting Statement Part B		03/07/2022

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

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