Information Collection

Longitudinal Cohort Second post-test evaluation survey

IC 216675 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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Longitudinal Cohort Second 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:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Incentive Lit Review	Attachment 4_ Incentive Lit Review.doc	No	Printable Only
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

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 %

	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

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.