Information Collection

PREtesting: No. to complete screener (assumes 50% eligible)

IC 224137 under ICR 201610-0910-009 · OMB 0910-0826.

Documents and Forms

Document Name Document Type
Appendix A Animation Consent Form 070716.pdf Other-Study Consent Form
Appendix B Animation Screener and Questionnaire 072716.pdf Other-Screener and Questionnaire
Appendix C Animation Recruitment Email 070716.pdf Other-Study Recruitment E-mail

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PREtesting: No. to complete screener (assumes 50% eligible)	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?	Can Be Submitted Electronically?	Electronic Capability
Other-Study Consent Form	Appendix A Animation Consent Form 070716.pdf	Yes	Yes	Fillable Fileable
Other-Screener and Questionnaire	Appendix B Animation Screener and Questionnaire 072716.pdf	Yes	Yes	Fillable Fileable
Other-Study Recruitment E-mail	Appendix C Animation Recruitment Email 070716.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 660	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	660	660
Annual IC Time Burden (Hours)	53	53
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.