Information Collection

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

IC 224139 under ICR 201610-0910-009 · OMB 0910-0826.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Study Consent Form	Yes	Yes	Fillable Fileable
Other-Screener and Questionnaire	Yes	Yes	Fillable Fileable
Other-Study Recruitment E-mail	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,300

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,300	3,300
Annual IC Time Burden (Hours)	264	264
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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