Cognitive Interview Screener

Experimental Study; Health Claims and Disclaimers About the Relationship Between Selenium and Risk of Various Cancers

Documents and Forms

Document Name Document Type
Experimental Study_Selenium Claims and Disclaimers Cognitive Interview Screener 121218.doc Other-Survey Screening Insturment

Information Collection (IC) Details

IC Title:	Cognitive Interview Screener	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-Survey Screening Insturment			Experimental Study_Selenium Claims and Disclaimers Cognitive Interview Screener 121218.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: 350	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	29	29
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.