Information Collection

Character Spaced Study

IC 227665 under ICR 201707-0910-014 · OMB 0910-0846.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix B - Questionnaire.docx	Other-Survey
Appendix A -- consent form.docx	Other-Consent Form
Appendix C -- recruitment email.docx	Other-Recruitment Emails

IC Title:

Agency IC Tracking Number:

CDER

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-Survey	Appendix B - Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-Consent Form	Appendix A -- consent form.docx	Yes	No	Paper Only
Other-Recruitment Emails	Appendix C -- recruitment email.docx	Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,502

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	6,502	6,502
Annual IC Time Burden (Hours)	1,128	1,128
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.