OMB
.report
Search
Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire (Post Intervention)
Registry of Unexplained Fatiguing Illnesses and Chronic Fatigue Syndrome (CFS): A Pilot Study
OMB: 0920-0788
IC ID: 183857
OMB.report
HHS/CDC
OMB 0920-0788
ICR 200802-0920-009
IC 183857
( )
Documents and Forms
Document Name
Document Type
Form No number
Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire (Post Intervention)
Form and Instruction
No number Provider Questionnaire - Post-intervention
Attachment 6b Provider Questionnaire (Knowledge Attitudes Beliefs) Post-Intervention.doc
Form and Instruction
Attachment 6a Physician Referral Instructions.doc
Attachment 6a Physician Referral Instructions
IC Document
Attachment 6a Non-physician referral instructions.doc
Attachment 6a Non-physician referral instructions
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Health Care Provider Knowledge, Attitudes and Beliefs Questionnaire (Post Intervention)
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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
No number
Provider Questionnaire - Post-intervention
Attachment 6b Provider Questionnaire (Knowledge Attitudes Beliefs) Post-Intervention.doc
Yes
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 62812
Number of Respondents:
373
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
373
0
373
0
0
0
Annual IC Time Burden (Hours)
50
0
50
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment 6a Physician Referral Instructions
Attachment 6a Physician Referral Instructions.doc
12/19/2007
Attachment 6a Non-physician referral instructions
Attachment 6a Non-physician referral instructions.doc
12/19/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.