Information Collection

Pretest

IC 212187 under ICR 201407-0910-002 · OMB 0910-0779.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Antiparasitic SurveyQuestionMap.docx	Other-Survey Question Map
Antiparasitic Mapping ExecSumm.docx	Other-Executive Summary of Survey Ma
FINAL Survey PDF.pdf	Other-Final Survey Instrument
Security Statement _ SurveyMonkey.pdf	Other-Survey Security Statement
Screenshot_1.PNG	Other-Survey screenshot 1
Screenshot_2.PNG	Other-Survey screenshot 2
Screenshot_3.PNG	Other-Survey screenshot 3
Screenshot_4.PNG	Other-Survey screenshot 4

IC Title:

Pretest

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Question Map	Antiparasitic SurveyQuestionMap.docx	Yes	Yes	Fillable Fileable
Other-Executive Summary of Survey Map	Antiparasitic Mapping ExecSumm.docx	Yes	Yes	Fillable Fileable
Other-Final Survey Instrument	FINAL Survey PDF.pdf	Yes	Yes	Fillable Fileable
Other-Survey Security Statement	Security Statement _ SurveyMonkey.pdf	No		Paper Only
Other-Survey screenshot 1	Screenshot_1.PNG	No		Paper Only
Other-Survey screenshot 2	Screenshot_2.PNG	No		Paper Only
Other-Survey screenshot 3	Screenshot_3.PNG	No		Paper Only
Other-Survey screenshot 4	Screenshot_4.PNG	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7	7
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.