Information Collection

Draft Online Questionnare With Convenience Sample

IC 191594 under ICR 201003-0910-001 · OMB 0910-0656.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
GF Online Conv. Sample Experiment Questionnaire Rev.10-14-09.docm	Other-Questionnaire

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Questionnaire			GF Online Conv. Sample Experiment Questionnaire Rev.10-14-09.docm		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,400	3,400
Annual IC Time Burden (Hours)	850	850
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.