Federal Register - January 28, 2021
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Source: Federal Register
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Federal Register / Vol. 86, No. 17 / Thursday, January 28, 2021 / Notices ESTIMATED ANNUALIZED BURDEN HOURSContinued Type of respondents Adult Adult Adult Adult Adult
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Adult
Adult Adult Adult Adult Adult Adult Adult Adult Adult Adult Adult Adult Adult Adult Adult Adult Adult
Adult
Adult
Adult
Adult
Adult
Adult
Adult
Adult
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Adult
Pediatric
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Pediatric Pediatric Pediatric Pediatric Pediatric Pediatric Pediatric Pediatric Pediatric Pediatric
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17:16 Jan 27, 2021
Multidimensional Fatigue Inventory MFI20
DePaul Symptom Questionnaire DSQ
DSQ, 26 selected questions
DSQ, 18 selected questions
PROMIS Short Form PROMIS SFFatigue, SD, SRI, PB, PI & Sleep Data Collection Form.
PROMIS SFFatigue, SD, SRI, PB, PI
Brief Pain Inventory BPI
Patient Health Questionnaire PHQ8, Generalized Anxiety Disorder GAD7, CDC Health-Related Quality of Life HRQoL4.
CDC HRQoL4
CDC HRQoL4 with activity limitation questions
Self-Rating Depression Scale SDS
Illness Impact Questionnaire
Saliva Data Collection Sheet
Orthostatic Grading Scale OGS
COMPosite Autonomic Symptom Score 31 COMPASS31
CDC Symptom Inventory CDCSI/Form A
CDC Symptom Inventory CDCSI/Form B
CDC Symptom Inventory CDCSI
Short Form CDCSI/Checklist
Medical Outcomes Study Short Form 36
Multidimensional Fatigue Inventory MFI20
DePaul Symptom Questionnaire DSQ
DSQ, 26 selected questions
DSQ, 18 selected questions
PROMIS Short Form PROMIS SFFatigue, SD, SRI, PB, PI & Sleep Data Collection Form.
PROMIS SFFatigue, SD, SRI, PB, PI
Brief Pain Inventory BPI
Patient Health Questionnaire PHQ8, Generalized Anxiety Disorder GAD7, CDC Health-Related Quality of Life HRQoL4.
CDC HRQoL4
CDC HRQoL4 with activity limitation questions
Self-Rating Depression Scale SDS
Illness Impact Questionnaire
Saliva Data Collection Sheet
Orthostatic Grading Scale OGS
COMPosite Autonomic Symptom Score 31 COMPASS31
CDC Symptom Inventory: For Baseline Subjects Pediatrics CDC Symptom Inventory: For the Follow-Up Subjects Pediatrics.
SF36 Health Survey
Multidimensional Fatigue Inventory MFI20
Selected Questions from DePaul Pediatric Health Questionnaire DPHQ, 19 Questions.
PROMIS Pediatric Instruments Fatigue & Pain
Pediatric Pain Questionnaire PPQ
Visual Analogue Scale
Hospital Anxiety and Depression Scale
Pediatric Daytime Sleepiness Scale
Social Participation Form Pediatric
Sociability Form
Saliva Collection Form
CDC Symptom Inventory: For Baseline Subjects Pediatrics CDC Symptom Inventory: For the Follow-Up Subjects Pediatrics.
SF36 Health Survey
Multidimensional Fatigue Inventory MFI20
Selected Questions from DePaul Pediatric Health Questionnaire DPHQ, 19 Questions.
PROMIS Pediatric Instruments Fatigue & Pain
Pediatric Pain Questionnaire PPQ
Visual Analogue Scale
Hospital Anxiety and Depression Scale
Pediatric Daytime Sleepiness Scale
Social Participation Form Pediatric
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Number of responses per participant
Number of participants
Form name
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E:FRFM28JAN1.SGM
Average burden per response in hrs.
85
45
65
85
85
1
1
1
1
1
5/60
24/60
12/60
6/60
5/60
85
85
85
1
1
1
4/60
13/60
10/60
85
85
45
85
85
85
85
24
30
15
69
69
69
24
45
69
24
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3/60
4/60
7/60
3/60
5/60
3/60
5/60
42/60
20/60
10/60
20/60
17/60
10/60
36/60
18/60
20/60
6/60
69
24
24
1
1
1
5/60
13/60
10/60
69
69
24
69
69
69
69
36
29
1
1
1
1
1
1
1
1
1
4/60
7/60
7/60
3/60
5/60
5/60
7/60
8/60
6/60
64
64
64
1
1
1
5/60
2/60
5/60
64
64
64
64
64
64
64
64
3
3
1
1
1
1
1
1
1
1
1
1
2/60
7/60
6/60
5/60
2/60
7/60
3/60
5/60
20/60
9/60
3
3
3
1
1
1
9/60
7/60
10/60
3
3
3
3
3
3
1
1
1
1
1
1
3/60
15/60
8/60
7/60
3/60
10/60
28JAN1
