Information Collection

Individuals Screened

IC 189373 under ICR 201208-0955-002 · OMB 0955-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0002 can be found here:

Documents and Forms

Document Name Document Type
0990-Facts for Consumers Statement-attahment.doc Other-Moderator Guide

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Individuals Screened	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Moderator Guide			0990-Facts for Consumers Statement-attahment.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 84	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	84	84
Annual IC Time Burden (Hours)	21	21
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.