OMB control number

Registry of Unexplained Fatiguing Illnesses and Chronic Fatigue Syndrome (CFS): A Pilot Study

OMB 0920-0788 · HHS/CDC.

OMB 0920-0788

Latest Forms, Documents, and Supporting Material

Document Name
Form No number Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire (at CDC presentation) Form and Instruction
Form No number Social Support Questionnaire Form
Form No number Ways of Coping Questionnaire Form
Form No number Illness Management Questionnaire Form
Form No number Ironson-Woods Spirituality / Religiousness Index Form and Instruction
Form No number Davidson Trauma Scale Form
Form No number Illness Perception Questionnaire Form
Form No number Zung Self-Rating Depression Scale Form
Form No number Multi-dimensional Fatigue Inventory Form
Form No number Medical Outcomes Study Short Form Form
Form No number Symptoms Inventory Form
Form No number Adolescent Health Questionnaire Form
Form No number Adolescent Subject Fatigue Questionnaire Form
Form No number Life Experiences Survey Form
Form No number Traumatic Life Events Questionnaire Form
Form No number Childhood Trauma Questionnaire Form
Form No number Personality Diagnostic Questionnaire Form
Form No number Spielberger State-Trait Anxiety Inventory Form
Form No number Economic Impact Form
Form No number Health Care Utilization (for parent of adolescent) Form
Form No number Health Care Utilization/Sense of Community (for adult) Form
Form No number CATI Detailed Telephone Interview Form
Form No number Referral/Consent to Contact Form - Patient Form
Form No number Referral/Consent to Contact Form - Provider Form
Form No number Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire (Post Intervention) Form and Instruction
Form No number Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire - Pre-Intervention Form and Instruction
Form No number Health Care Provider Verification Form Form and Instruction
Followup CFS in GA - OMB Supporting Statement Rev 05-22-08.doc Supplementary Document
OMB Supporting Statement for Registry Redlined May 2008.doc Supplementary Document
Attachment 22 Symptoms Inventory.doc Supplementary Document
Attachment 20 Clinic Appointment letters for adults.doc Supplementary Document
Attachment 19 Post clinical evaluation ineligibility letter.doc Supplementary Document
Attachment 18-Hard to contact letter.doc Supplementary Document
Attachment 17 Justification of Non exempted Clniical Questionnaires .doc Supplementary Document
Attachment 16 Psychiatric history - structured clinical interview for the DSM IV Scoring.doc Supplementary Document
Attachment 15 Physical Exam Form.doc Supplementary Document
Attachment 14. Two week medication usage history.doc Supplementary Document
Attachment 13 12 hour urine collection instructions.doc Supplementary Document
Attachment 12 Saliva specimen collection instructions.doc Supplementary Document
Attachment 11b Adolescent gynecologic history form.doc Supplementary Document
Attachment 10b Adolescent Medical History Form.doc Supplementary Document
Attachment 10a Adult Medical history Form.doc Supplementary Document
Attachment 8b Website content for general public.doc Supplementary Document
Attachment 8a.1 Recruitment Letter for Adults.doc Supplementary Document
Attachment 11a Adult gynecological history form.doc Supplementary Document
2007 Registry Pilot 60-day notice.pdf Supplementary Document
Attachment 2 Congressional Language 2003-2006.doc Supplementary Document
Attachment 1 Authorizing Legislation.doc Supplementary Document
Attachment 24 Social Support Questionnaire OMB Cover page.doc Supplementary Document
Attachment 24 Ways of Coping Questionnaire OMB cover page.doc Supplementary Document
Attachment 23 Davidson Trauma Scale OMB Cover page.doc Supplementary Document
Attachment 24 Illness Perception Questionnaire OMB Cover sheet.doc Supplementary Document
Attachment 23 Zung Self-Rating Depression Scale OMB cover page.doc Supplementary Document
Attachment 22 Multi-dimensional Fatigue Inventory OMB cover sheet.doc Supplementary Document
Attachment 22 Multi-dimensional Fatigue Inventory OMB cover sheet.doc Supplementary Document
Attachment 25 Life Experiences Survey for adults OMB Cover page.doc Supplementary Document
Attachment 25 Traumatic Life Events Questionnaire OMB Cover Page.doc Supplementary Document
Attachment 25 Childhood Trauma Questionniare for adults OMB cover page.doc Supplementary Document
Attachment 23 Personality Diagnostic Questionnaire (PDQ4+) OMB cover page.doc Supplementary Document
Attachment 23 State Trait Anxiety Inventory for adults OMB cover page.doc Supplementary Document
Attachment 6a Non-physician referral instructions.doc Supplementary Document
Attachment 6a Physician Referral Instructions.doc Supplementary Document
Attachment 6a Physician Referral Instructions.doc Supplementary Document
Attachment 6a Non-physician referral instructions.doc Supplementary Document
Attachment 5b Provider website Frequently Asked Questions.doc Supplementary Document
Attachment 5a.3. Frequently Asked Questions by Healthcare Providers .doc Supplementary Document
Attachment 5a.1.Provider recruitment letter.doc Supplementary Document
OMB Supporting Statement for Registry 4 120107.doc Supporting Statement A
Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire (at CDC presentation) Form and Instruction
Social Support Questionnaire Form
Ways of Coping Questionnaire Form
Illness Management Questionnaire Form
Ironson-Woods Spirituality / Religiousness Index Form and Instruction
Davidson Trauma Scale Form
Illness Perception Questionnaire Form
Zung Self-Rating Depression Scale Form
Multi-dimensional Fatigue Inventory Form
Medical Outcomes Study Short Form Form
Symptoms Inventory Form
Adolescent Health Questionnaire Form
Adolescent Subject Fatigue Questionnaire Form
Life Experiences Survey Form
Traumatic Life Events Questionnaire Form
Childhood Trauma Questionnaire Form
Personality Diagnostic Questionnaire Form
Spielberger State-Trait Anxiety Inventory Form
Economic Impact Form
Health Care Utilization (for parent of adolescent) Form
Health Care Utilization/Sense of Community (for adult) Form
CATI Detailed Telephone Interview Form
Referral/Consent to Contact Form - Patient Form
Referral/Consent to Contact Form - Provider Form
Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire (Post Intervention) Form and Instruction
Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire - Pre-Intervention Form and Instruction
Health Care Provider Verification Form Form and Instruction

All Historical Document Collections

200802-0920-009

Approved with change

New collection (Request for a new OMB Control Number)

2008-02-25