Information Collection

Phase I - Screener

IC 196070 under ICR 201101-0910-009 · OMB 0910-0691.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Quantitative Questionnaire.doc	Other-Quantitative Questionnaire
Formative guide - 06-23-11.doc	Other-Formative Guide

IC Title:

Phase I - Screener

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 208 21 CFR 310.501.21 21 CFR 310.515

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-Quantitative Questionnaire			Quantitative Questionnaire.doc		Yes	No	Fillable Printable
Other-Formative Guide			Formative guide - 06-23-11.doc		No		Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	400	400
Annual IC Time Burden (Hours)	13	13
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.