Number of Completes - Screener

Experimental Study: Disease Information in Branded Promotional Material

Documents and Forms

Document Name Document Type
APPENDIX 2_questionnaire_FINAL.doc Other-Screener and Questionnaires
APPENDIX 4_consent.doc Other-Appendix 4

Information Collection (IC) Details

IC Title:	Number of Completes - Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 21 CFR 202.1(e)(6)(i)

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,688	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	9,688	9,688
Annual IC Time Burden (Hours)	323	323
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.