Information Collection

Study 1 - Mall Intercept

IC 199762 under ICR 201110-0910-006 · OMB 0910-0713.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0713 can be found here:

Documents and Forms

Document Name Document Type
Mall Intercept-Recruitment Script.doc Other-Script

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Study 1 - Mall Intercept	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 202.1(e)(2)(i) 21 CFR 202.1(e)(5) and (ii) 21 CFR 202.1(e)(6)(i)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Script			Mall Intercept-Recruitment Script.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,950	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	1,950	1,950
Annual IC Time Burden (Hours)	650	650
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.