Information Collection Request

Medical Monitoring Project

ICR 201107-0920-002 · OMB 0920-0740 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Patients Standard Interview Form Modified Available
MMP 2011 Protocol_clean.pdf Supplementary Document Uploaded 2011-07-06 Available
0920-0740_OMB_Justification_2011.docx Justification for No Material/Nonsubstantive Change Uploaded 2011-07-06 Available
Attachment12_ProviSurveyLtrs.doc Supplementary Document Uploaded 2009-03-12 Available
Attachment11_Model Scripts.doc Supplementary Document Uploaded 2009-03-12 Available
IC Document Collections
IC IDCollectionTypeStatusForm
180569 Patients approached by facility staff for enrollment Instruction Modified
180568 Facility staff providing patient lists Instruction Modified
180566 Facility staff Providing Estimated Patient Loads Instruction Modified
180565 Facility Staff Medical Record Abstraction Instruction Modified
178498 Patient Short interview Instruction Modified
178497 Patients Standard Interview Form Modified
ICR Details
0920-0740 201107-0920-002
Historical Active 201002-0920-010
HHS/CDC
Medical Monitoring Project
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 07/20/2011
Retrieve Notice of Action (NOA) 07/06/2011
  Inventory as of this Action Requested Previously Approved
05/31/2012 05/31/2012 05/31/2012
20,045 0 20,045
8,500 0 8,500
0 0 0

This is a request to add telephone interviews as an option for data collection to the MMP.

US Code: 42 USC 301 (241.)a. Name of Law: Research and investigations generally
  
None

Not associated with rulemaking

Yes

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 20,045 20,045 0 0 0 0
Annual Time Burden (Hours) 8,500 8,500 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$13,714,425
Yes Part B of Supporting Statement
Yes
No
No
No
Uncollected
Daniel Holcomb 770 488-4472 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/06/2011