Information Collection

Sub-study #1_Self-Affirmation and Affect

IC 201753 under ICR 201111-0925-003 · OMB 0925-0645.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0645 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Sub-study #1_Self-Affirmation and Affect	Form and Instruction
1 Self-Affirmation Survey #1_Attach 1A_Self-Affirm Suvey.doc	Form and Instruction
#1_Attach 1C_Readings.doc #1_Attach 1C_Readings	IC Document
#1_Gen IC Form_Self-Affirm.doc #1_Gen IC Form_Self-Affirm	IC Document
#1_Justif Memo_Self-Affirm03_27_2012.doc #1_Justif Memo_Self-Affirm03_27_2012	IC Document
#1_Attach 1B_Self- Affirm Survey Screenshots.doc #1_Attach 1B_Self- Affirm Survey Screenshots	IC Document

IC Title:

Sub-study #1_Self-Affirmation and Affect

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
Form and Instruction	1	Self-Affirmation Survey	#1_Attach 1A_Self-Affirm Suvey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	800	0	0	0	0	0
Annual IC Time Burden (Hours)	400	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
#1_Attach 1C_Readings	#1_Attach 1C_Readings.doc	03/23/2012
#1_Gen IC Form_Self-Affirm	#1_Gen IC Form_Self-Affirm.doc	03/23/2012
#1_Justif Memo_Self-Affirm03_27_2012	#1_Justif Memo_Self-Affirm03_27_2012.doc	03/27/2012
#1_Attach 1B_Self- Affirm Survey Screenshots	#1_Attach 1B_Self- Affirm Survey Screenshots.doc	03/27/2012

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