Information Collection Request
[NCHHSTP] Medical Monitoring Project
ICR 202402-0920-006 · OMB 0920-0740 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-0740 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Model Patient Recruitment Script - Facility |
Form and Instruction | Modified | Repair queued |
| Interview Questionnaire |
Form and Instruction | Modified | Repair queued |
 Att 17 Sample sizes.docx |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
| Att 16 Agreement To Abide by Restrictions.docx |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
 Att 15 DCC ATO.pdf |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
| Att 14 Project Determination MMP.pdf |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
| Att 13 Assurance of Confidentiality.docx |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
| Att 12 WISMS PIA_signed.pdf |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
| Att 11 Consultations Conducted Before 2010.docx |
Supplementary Document | Uploaded 2024-04-10 | Missing upstream |
| Att 10 MMP Bibliography.docx |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
| Att 9 MMP_CrossJuris_Agreement_MMP 2024_Cycle.docx |
Supplementary Document | Uploaded 2024-04-10 | Missing upstream |
| Att 8d Recruitment Text E-mail.docx |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
| Att 8b Recruitment Script Project Staff.docx |
Supplementary Document | Uploaded 2024-04-10 | Repair queued |
| Att 8a Model Recruitment Letter.docx |
Supplementary Document | Uploaded 2024-04-10 | Missing upstream |
| Att 7 References 2023 12 12 clean.docx |
Supplementary Document | Uploaded 2024-02-14 | Repair queued |
| Att 6 MMP MRA Data Structure _2024.docx |
Supplementary Document | Uploaded 2024-02-14 | Missing upstream |
| Att 5d Summary of changes to questionnaire 2024 2023 07 25.docx |
Supplementary Document | Uploaded 2024-02-14 | Repair queued |
| Att 5c MMP 2021 Questionnaire English.pdf |
Supplementary Document | Uploaded 2024-02-14 | Repair queued |
| Att 4 MMP Minimum Dataset Elements.docx |
Supplementary Document | Uploaded 2024-02-14 | Repair queued |
| Att 3 MMP 2024-2026 Model Consent.docx |
Supplementary Document | Uploaded 2024-02-14 | Repair queued |
| Att 2_60-Day FRN.pdf |
Supplementary Document | Uploaded 2024-02-14 | Repair queued |
| Att 1_Sect 301 PHSA.PDF |
Supplementary Document | Uploaded 2024-02-14 | Repair queued |
| MMP-SSB_2023 12 12 clean.docx |
Supporting Statement B | Uploaded 2024-02-14 | Repair queued |
| MMP-SSA_2024 02 16 clean.docx |
Supporting Statement A | Uploaded 2024-04-10 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 180569 |  Pull Medical Records |
Instruction | Modified | |
| 180568 | Lookup Contact Information |
Instruction | Modified | |
| 180566 | Model Patient Recruitment Script - Facility |
Form and Instruction | Modified | |
| 180565 | Interview Questionnaire |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CDC |
| OMB Control No | 0920-0740 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202101-0920-006 |
| Agency Tracking No | 0920-0740 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |