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⚠️ Notice: This information collection may be outdated.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:

2025-05-01 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
Model Patient Recruitment Script - Facility Form and Instruction	Modified
Interview Questionnaire Form and Instruction	Modified
Att 17 Sample sizes.docx Supplementary Document	2024-04-10
Att 16 Agreement To Abide by Restrictions.docx Supplementary Document	2024-04-10
Att 15 DCC ATO.pdf Supplementary Document	2024-04-10
Att 14 Project Determination MMP.pdf Supplementary Document	2024-04-10
Att 13 Assurance of Confidentiality.docx Supplementary Document	2024-04-10
Att 12 WISMS PIA_signed.pdf Supplementary Document	2024-04-10
Att 11 Consultations Conducted Before 2010.docx Supplementary Document	2024-04-10
Att 10 MMP Bibliography.docx Supplementary Document	2024-04-10
Att 9 MMP_CrossJuris_Agreement_MMP 2024_Cycle.docx Supplementary Document	2024-04-10
Att 8d Recruitment Text E-mail.docx Supplementary Document	2024-04-10
Att 8b Recruitment Script Project Staff.docx Supplementary Document	2024-04-10
Att 8a Model Recruitment Letter.docx Supplementary Document	2024-04-10
Att 7 References 2023 12 12 clean.docx Supplementary Document	2024-02-14
Att 6 MMP MRA Data Structure _2024.docx Supplementary Document	2024-02-14
Att 5d Summary of changes to questionnaire 2024 2023 07 25.docx Supplementary Document	2024-02-14
Att 5c MMP 2021 Questionnaire English.pdf Supplementary Document	2024-02-14
Att 4 MMP Minimum Dataset Elements.docx Supplementary Document	2024-02-14
Att 3 MMP 2024-2026 Model Consent.docx Supplementary Document	2024-02-14
Att 2_60-Day FRN.pdf Supplementary Document	2024-02-14
Att 1_Sect 301 PHSA.PDF Supplementary Document	2024-02-14
MMP-SSB_2023 12 12 clean.docx Supporting Statement B	2024-02-14
MMP-SSA_2024 02 16 clean.docx Supporting Statement A	2024-04-10

IC Document Collections

IC ID	Document Title	Status
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