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Instruments for Wave 3 of the PATH Study
Population Assessment of Tobacco and Health (PATH) Study - Fourth Wave of Data Collection (NIDA)
OMB: 0925-0664
IC ID: 212557
OMB.report
HHS/NIH
OMB 0925-0664
ICR 201606-0925-008
IC 212557
( )
Documents and Forms
Document Name
Document Type
Form 1-Rev
Instruments for Wave 3 of the PATH Study
Form and Instruction
1-Rev PATH Data Collection Instruments for Wave 3 English and
2 PATH Study Data Collection Instruments.pdf
Form and Instruction
2 Follow up, Retention and Tracking Documents - English Ve
9 Followup, Retention, and Tracking Materials.pdf
Form and Instruction
3-New PATH Verification Form
23_PATH Verification Form (new) 5-8-15.pdf
Form and Instruction
3-New PATH Validation Form
24_PATH Validation Form (new) 5-8-15.pdf
Form and Instruction
5 Summary of Changes to PATH Study Instruments.pdf
Summary of Changes to the Instrument for Wave 3
IC Document
6 Additional Information on Biospecimens.pdf
Additional Biospecimen Information for Wave 3
IC Document
19 Field Data Collection Materials.pdf
Field Materials - English and Spanish for Wave 3
IC Document
17 Procedures for Keeping Data Confidential.pdf
Data Confidentially Procedures for Wave 3
IC Document
18 ICPSR Data Use Agreement.pdf
Data Use Agreement for Wave 3
IC Document
8 Key Design Features.pdf
Key Survey Design Features for Wave 3
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Instruments for Wave 3 of the PATH Study
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1-Rev
PATH Data Collection Instruments for Wave 3 English and Spanish Versions
2 PATH Study Data Collection Instruments.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
2
Follow up, Retention and Tracking Documents - English Version
9 Followup, Retention, and Tracking Materials.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
3-New
PATH Verification Form
23_PATH Verification Form (new) 5-8-15.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
3-New
PATH Validation Form
24_PATH Validation Form (new) 5-8-15.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-25-0200 Clinical, Basic and Population-based Research Studies of the National Institutes of Health (NIH), HHSAIIH/OD
FR Citation:
67 FR 60741
Number of Respondents:
41,662
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
90 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
0
0
-192,858
0
0
192,858
Annual IC Time Burden (Hours)
0
0
-54,434
0
0
54,434
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Summary of Changes to the Instrument for Wave 3
5 Summary of Changes to PATH Study Instruments.pdf
06/19/2015
Additional Biospecimen Information for Wave 3
6 Additional Information on Biospecimens.pdf
06/19/2015
Field Materials - English and Spanish for Wave 3
19 Field Data Collection Materials.pdf
06/19/2015
Data Confidentially Procedures for Wave 3
17 Procedures for Keeping Data Confidential.pdf
06/19/2015
Data Use Agreement for Wave 3
18 ICPSR Data Use Agreement.pdf
06/19/2015
Key Survey Design Features for Wave 3
8 Key Design Features.pdf
06/19/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.