Number to Complete the Screener

Experimental Study of Format Variations in the Brief Summary of Direct-to-Consumer (DTC) Print Advertisements

Documents and Forms

Document Name Document Type
APPENDIX E - Screener.doc Other-Screener

Information Collection (IC) Details

IC Title:	Number to Complete the Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Screener			APPENDIX E - Screener.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 69,118	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	69,118	69,118
Annual IC Time Burden (Hours)	2,304	2,304
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.