Information Collection

Longitudinal Cohort - First post-test evaluation survey

IC 215947 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Attachment 4_ Incentive Lit Review.doc	Other-Incentive Lit Review
Attachment 16_Verification Form.docx	Other-Verification Form
Attachment 17_Verification Call Script.doc	Other-Verification Call Script
Attachment 18_Verification Letter.docx	Other-Verification Letter

IC Title:

Longitudinal Cohort - First post-test evaluation survey

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?	Electronic Capability
Other-Verification Form	Attachment 16_Verification Form.docx	No	Printable Only
Other-Verification Call Script	Attachment 17_Verification Call Script.doc	No	Printable Only
Other-Verification Letter	Attachment 18_Verification Letter.docx	No	Printable Only
Other-Incentive Lit Review	Attachment 4_ Incentive Lit Review.doc	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,365

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	1,365	1,365
Annual IC Time Burden (Hours)	1,024	1,024
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.