Information Collection

Fall 2009 Media Tracking Survey(unretained for follow-up

IC 188801 under ICR 200904-0990-002 · OMB 0990-0345.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0990 Fall 2009 Media Tracking Survey(unretained for follow-up	Form
0990 Debriefing 0990-PSUNC-Tracking Survey-Debriefing Form.doc	Form
0990-PSUNC-TrackingSurvey-Knowledge Networks Panel Recruitment Methodology.doc 0990-PSUNC-TrackingSurvey-Knowledge Networks Panel Recruitment Methodology	IC Document
0990-PSUNC-TrackingSurvey-Assurances of Confidentiality and Study Consent.doc 0990-PSUNC-TrackingSurvey-Assurances of Confidentiality and Study Consent	IC Document
0990-PSUNC-TrackingSurvey-Knowledge Networks Privacy and Confidentiality Procedures.doc 0990-PSUNC-TrackingSurvey-Knowledge Networks Privacy and Confidentiality Procedures	IC Document
0990-PSUNC-TrackingSurvey-RTI IRB Approval Notice 02-24-09.pdf IRB	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0990	Debriefing	0990-PSUNC-Tracking Survey-Debriefing Form.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-PSUNC-TrackingSurvey-Knowledge Networks Panel Recruitment Methodology	0990-PSUNC-TrackingSurvey-Knowledge Networks Panel Recruitment Methodology.doc	04/07/2009
0990-PSUNC-TrackingSurvey-Assurances of Confidentiality and Study Consent	0990-PSUNC-TrackingSurvey-Assurances of Confidentiality and Study Consent.doc	04/07/2009
0990-PSUNC-TrackingSurvey-Knowledge Networks Privacy and Confidentiality Procedures	0990-PSUNC-TrackingSurvey-Knowledge Networks Privacy and Confidentiality Procedures.doc	04/07/2009
IRB	0990-PSUNC-TrackingSurvey-RTI IRB Approval Notice 02-24-09.pdf	04/07/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.