Information Collection

CelebritiesPrescrition Drugs and Salmon

IC 209621 under ICR 201403-0925-011 · OMB 0925-0700.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 CelebritiesPrescrition Drugs and Salmon	Form and Instruction
1 Screenshot: Celebrities, Prescription Drugs & Salmon Attach 15. Screenshot Celebrities, Prescription Drugs & Salmon-McBride.pdf	Form and Instruction
Attach 14. Celebrities, Prescription Drugs & Salmon-McBride.pdf Attach 14	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	1	Screenshot: Celebrities, Prescription Drugs & Salmon	Attach 15. Screenshot Celebrities, Prescription Drugs & Salmon-McBride.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach 14	Attach 14. Celebrities, Prescription Drugs & Salmon-McBride.pdf	03/24/2014

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