Information Collection

CROPS Demonstrators Pretest

IC 192705 under ICR 201004-0920-010 · OMB 0920-0854.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CROPS_Appx C.1a_Demonstrator PreTest.doc	Other-WORD
CROPS_Appx F1_Demonstrators Consent.doc Demonstrator Informed Consent	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
Other-WORD			CROPS_Appx C.1a_Demonstrator PreTest.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 74 FR 48078

Number of Respondents: 30

Number of Respondents for Small Entity: 30

Affected Public: Private Sector

Private Sector: Farms

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	30	30
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Demonstrator Informed Consent	CROPS_Appx F1_Demonstrators Consent.doc	03/08/2010

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