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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
0990-Facts for Consumers Statement-attahment.doc	Other-Moderator Guide

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.