Main Study Screener

Risk and Benefit Perception Scale Development

Documents and Forms

Document Name Document Type
QUESTIONNAIRE 0784 6-9-2015.docx Other-Questionnaire
SCALE DEVELOPMENT 30 DAY FRN 10-28-14.doc Scale Development IC Document

Information Collection (IC) Details

IC Title:	Main Study Screener	Agency IC Tracking Number:	CDER

Is this a Common Form? No		IC Status: Modified

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-Questionnaire			QUESTIONNAIRE 0784 6-9-2015.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: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Scale Development	SCALE DEVELOPMENT 30 DAY FRN 10-28-14.doc	11/25/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.