Information Collection

Number of Main Study Screener Completes (assumes 10% eligible)

IC 217228 under ICR 201506-0910-030 · OMB 0910-0803.

Documents and Forms

Document Name Document Type
FINAL QUESTIONNAIRE.docx Other-Survey
FINAL SCREENER.docx Other-Screener

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Number of Main Study Screener Completes (assumes 10% eligible)	Agency IC Tracking Number:	CDER

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-Survey			FINAL QUESTIONNAIRE.docx		Yes	Yes	Fillable Fileable
Other-Screener			FINAL SCREENER.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: 6,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	480	480
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.