Information Collection

Study 3

IC 200956 under ICR 201201-0910-006 · OMB 0910-0714.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0714 can be found here:

Documents and Forms

Document Name Document Type
Phase 3 Questionnaire - Depression.doc Other-questionnaire

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Study 3	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 202.1(e)(5) and (ii)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-questionnaire			Phase 3 Questionnaire - Depression.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	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	1,000	1,000
Annual IC Time Burden (Hours)	417	417
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.