Information Collection

CRC Pre-Test Participants Including Control Group

IC 211512 under ICR 201405-0920-003 · OMB 0920-1023.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1023 can be found here:

Documents and Forms

Document Name Document Type
CRC Pre-Test Participants Including Control Group Form
Overview of Survey and Screenshots Attachment 2 Overview of Survey and Screen Shots.docx Form
Attachment 3 Experimental Design and 10 Blocks of DCE Questions.docx Overview of Experimental Design IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CRC Pre-Test Participants Including Control Group	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form	none	Overview of Survey and Screenshots	Attachment 2 Overview of Survey and Screen Shots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 677	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	677	677
Annual IC Time Burden (Hours)	248	248
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Overview of Experimental Design	Attachment 3 Experimental Design and 10 Blocks of DCE Questions.docx	05/05/2014

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