Information Collection

Main Study Screener

IC 214031 under ICR 201510-0910-008 · OMB 0910-0784.

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.