Information Collection Request

Facts for Consumers About Health

ICR 201211-0955-001 · OMB 0955-0002 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
0955-0002_FACTS FOR CONSUMER_PT B.docx Supporting Statement B Uploaded 2012-10-31 Available
Attachment C OMB 0955-0002.docx Supplementary Document Uploaded 2012-10-31 Available
0955-0002_Factfor Consumer.docx Supporting Statement A Uploaded 2012-11-02 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
189374 Participants selected Other-guide Modified
189373 Individuals Screened/Coginitive testing Other-telephone script Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2016 36 Months From Approved
156 0 0
104 0 0
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Individuals Screened/Coginitive testing
Participants selected

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 156 0 0 30 0 126
Annual Time Burden (Hours) 104 0 0 20 0 84
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No