[NCHHSTP] Medical Monitoring Project

ICR 202503-0920-027

OMB: 0920-0740

Federal Form Document

Forms and Documents

Document Name	Status
Model Patient Recruitment Script - Facility Form and Instruction	Unchanged
Interview Questionnaire Form and Instruction	Modified
Justification Memo for Nonsubstantive Change Req_MMP 0920-0740.docx Justification for No Material/Nonsubstantive Change	2025-03-24
Att 2b_MMP MRA Data Structure_clean.docx Supplementary Document	2025-03-24
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 amended.docx Supporting Statement A	2024-05-15

IC Document Collections

IC ID	Document Title	Status
180569	Pull Medical Records Instruction	Unchanged
180568	Lookup Contact Information Instruction	Unchanged
180566	Model Patient Recruitment Script - Facility Form and Instruction	Unchanged
180565	Interview Questionnaire Form and Instruction	Modified