Information Collection

Poison Help General Population Survey

IC 198611 under ICR 201107-0915-001 · OMB 0915-0343.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0343 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Poison Help General Population Survey Form
1 Poison Help Survey Screener Poison Help Survey Screener_10.17.11.docx Form
2 Poison Help Survey Final Poison Help Survey_Final_10.17.11.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Poison Help General Population Survey	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	1	Poison Help Survey Screener	Poison Help Survey Screener_10.17.11.docx		No		Printable Only
Form	2	Poison Help Survey Final	Poison Help Survey_Final_10.17.11.docx		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,353	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	2,353	2,353
Annual IC Time Burden (Hours)	370	370
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.