Information Collection

CRC Study Participants including Control Group

IC 211513 under ICR 201501-0920-013 · OMB 0920-1023.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CRC Study Participants including Control Group	Form
Overview of Survey and Screenshots Att 2 Overview of Survey and Screen Shots REV 12JAN2015.docx	Form
Attachment 3 Experimental Design and 10 Blocks of DCE Questions.docx Overview of Experimental Design	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	none	Overview of Survey and Screenshots	Att 2 Overview of Survey and Screen Shots REV 12JAN2015.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: 1,353

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,353	1,353
Annual IC Time Burden (Hours)	564	564
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.