Information Collection

Pretesting

IC 225316 under ICR 201701-0910-015 · OMB 0910-0831.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix C Super Recruitment Emails 071416.docx	Other-Recruitment E-mails
Appendix A Super Consent Form 091416.docx	Other-Consent Form
Appendix B Super Screener and Questionnaires 091416.docx	Other-Screener and Questionnaires

IC Title:

Pretesting

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Recruitment E-mails	Appendix C Super Recruitment Emails 071416.docx	Yes	Yes	Fillable Fileable
Other-Consent Form	Appendix A Super Consent Form 091416.docx	Yes	Yes	Fillable Fileable
Other-Screener and Questionnaires	Appendix B Super Screener and Questionnaires 091416.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: 578

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	578	578
Annual IC Time Burden (Hours)	128	128
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.