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

Latest forms, documents, and information collections
Document	Type
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

Historical document collections
Reference	Filing	Received	Concluded	Action
200802-0920-009	New collection (Request for a new OMB Control Number)	2008-02-25		Approved with change