Self-administered questionnaire

Understanding Patient's Knowledge and Use of Acetaminophen

Documents and Forms

Document Name Document Type
Form Form #2 Self-administered questionnaire Form
Form #2 Self-administered Questionnaire Attachment G -- Self-Administered Questionnaire.pdf Form

Information Collection (IC) Details

IC Title:	Self-administered questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Form #2	Self-administered Questionnaire	Attachment G -- Self-Administered Questionnaire.pdf		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 84	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	84	84
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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