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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.