Information Collection

Cognitive Interviews for Risk and Benefit Perception Scale Development Study

IC 210814 under ICR 201106-0910-004 · OMB 0910-0695.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0695 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix C -- Cognitivie Interview Guide and Questionnaire.doc	Other-Guide & Questionnaire
Appendix A -- Screener.doc	Other-other
Appendix B -- Consent Form.doc Appendix B -- Consent Form	IC Document
OMB Justification for generic clearance of DTC TV AD study 3-14-14.doc OMB Justification for generic clearance of DTC TV AD study 3-14-14	IC Document

IC Title:

Cognitive Interviews for Risk and Benefit Perception Scale Development Study

Agency IC Tracking Number:

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-Guide & Questionnaire			Appendix C -- Cognitivie Interview Guide and Questionnaire.doc		Yes	Yes	Fillable Fileable Signable
Other-other			Appendix A -- Screener.doc		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 603

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	603	0	0	0	0	0
Annual IC Time Burden (Hours)	44	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix B -- Consent Form	Appendix B -- Consent Form.doc	03/14/2014
OMB Justification for generic clearance of DTC TV AD study 3-14-14	OMB Justification for generic clearance of DTC TV AD study 3-14-14.doc	03/18/2014

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