Information Collection

Survey

IC 202088 under ICR 201204-0990-003 · OMB 0990-0399.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0399 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-Appendix A Web based Survey Evaluation titled The Lab Word Document (2).docx	Other-survey
0990-EIVRI_consentAppendix C.docx 0990-EIVRI_consentAppendix C	IC Document

IC Title:

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
Other-survey			0990-Appendix A Web based Survey Evaluation titled The Lab Word Document (2).docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,000

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	6,000	6,000
Annual IC Time Burden (Hours)	2,100	2,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-EIVRI_consentAppendix C	0990-EIVRI_consentAppendix C.docx	04/19/2012

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