OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Number of Completes - Screener

IC 202839 under ICR 201211-0910-008 · OMB 0910-0724.

Documents and Forms
Document Name
Document Type
Other-Screener and Questionnaires
Other-Appendix 4
Information Collection (IC) Details

View Information Collection (IC)

Number of Completes - Screener
 
No Modified
 
Required to Obtain or Retain Benefits
 
21 CFR 202.1(e)(6)(i)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screener and Questionnaires APPENDIX 2_questionnaire_FINAL.doc Yes Yes Printable Only
Other-Appendix 4 APPENDIX 4_consent.doc No No Printable Only

Health Illness Prevention

 

9,688 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 9,688 0 0 0 0 9,688
Annual IC Time Burden (Hours) 323 0 0 0 0 323
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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