Information Collection

Pretest

IC 204490 under ICR 201210-0910-001 · OMB 0910-0730.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HCP Survey_Appendix B_Pretest Survey.docx	Other-Survey
HCP Survey_Appendix C_Pretest EmailsReminders.doc HCP Survey_Appendix C_Pretest EmailsReminders	IC Document

IC Title:

Pretest

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			HCP Survey_Appendix B_Pretest Survey.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HCP Survey_Appendix C_Pretest EmailsReminders	HCP Survey_Appendix C_Pretest EmailsReminders.doc	02/05/2013

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