Information Collection

Adults 18 and older in the United States - Screener and Consent Process-Pre-test outcome survey

IC 215942 under ICR 201504-0910-001 · OMB 0910-0788.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0788 can be found here:

Documents and Forms

Document Name Document Type
Attachment 2_Outcome Mail Screener.docx Other-Outcome Mail Screener

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adults 18 and older in the United States - Screener and Consent Process-Pre-test outcome survey	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
Other-Outcome Mail Screener			Attachment 2_Outcome Mail Screener.docx		No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,816	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,816	13,816
Annual IC Time Burden (Hours)	229	229
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.