Information Collection Request

[NCEZID] School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out

ICR 202212-0920-001 · OMB 0920-1396 · Received in OIRA

Forms and Documents

Document Name	Status
Form 0920-22HN School District Feedback Form Form and Instruction	New
Form 920-22HN Webinar 1 Feedback Form Form and Instruction	New
Form 0920-22HN Question Guide for Face-to-Face Evaluation Interviews Form and Instruction	New
Form 0920-22HN Site Baseline Survey Form and Instruction	New
Form 0920-22HN Demographic Data Collection Points Form and Instruction	New
Form 0920-22HN Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form Form and Instruction	New
2022-26886- 30DAY FRN PUBLISHED 12122022.pdf Supplementary Document	2022-12-13
Attachment I_SBAS_Consent Form and Authorization for School District Representatives.docx Supplementary Document	2022-12-01
Attachment J_SBAS_Consent Form and Authorization for School Nurses.docx Supplementary Document	2022-12-01
Attachment H_SBAS_NASN IRB Exempt Determination Notice.pdf Supplementary Document	2022-12-01
Attachment G_SBAS_Privacy Act Checklist Active Surveillance School Age Children.docx Supplementary Document	2022-12-01
Supporting Statement B_SBAS.docx Supporting Statement B	2022-12-01
Supporting Statement A_SBAS.docx Supporting Statement A	2022-12-01

IC Document Collections

IC ID	Document Title	Status
257211	School District Feedback Form Form and Instruction	New
257210	Webinar 1 Feedback Form Form and Instruction	New
257209	Question Guide for Face-to-Face Evaluation Interviews Form and Instruction	New
257208	Site Baseline Survey Form and Instruction	New
257207	Demographic Data Collection Points Form and Instruction	New
257206	Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form Form and Instruction	New

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CDC
OMB Control No	0920-1396
Type of Information Collection	New collection (Request for a new OMB Control Number)
Agency Tracking No	0920-22HN
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31