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Pilot Survey
National Survey of Health Information and Communication
OMB: 0910-0828
IC ID: 224063
OMB.report
HHS/FDA
OMB 0910-0828
ICR 201707-0910-015
IC 224063
( )
Documents and Forms
Document Name
Document Type
Appendix A Survey.pdf
Other-Survey
Appendix B Landing Page Text.pdf
Other-Survey Landing page
Appendix C Contact 1_Letter.pdf
Other-Survey Contact Letter
Appendix D Contact 2_Postcard.pdf
Other-Survey Contact Postcard
Appendix E Contact 3_Letter.pdf
Other-Survey Contact Letter 2
Appendix F Contact 4_Letter.pdf
Other-Survey Contact Letter 3
Appendix G Contact 5_Postcard.pdf
Other-Survey Contact Postcard 2
0828 83C Justification Memorandum 4-20-2017.docx
OMB Justification Memo
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Pilot Survey
Agency IC Tracking Number:
CDER
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Survey
Appendix A Survey.pdf
Yes
Yes
Fillable Fileable
Other-Survey Landing page
Appendix B Landing Page Text.pdf
Yes
Yes
Fillable Fileable
Other-Survey Contact Letter
Appendix C Contact 1_Letter.pdf
Yes
Yes
Fillable Fileable
Other-Survey Contact Postcard
Appendix D Contact 2_Postcard.pdf
Yes
Yes
Fillable Fileable
Other-Survey Contact Letter 2
Appendix E Contact 3_Letter.pdf
Yes
Yes
Fillable Fileable
Other-Survey Contact Letter 3
Appendix F Contact 4_Letter.pdf
Yes
Yes
Fillable Fileable
Other-Survey Contact Postcard 2
Appendix G Contact 5_Postcard.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
118
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
118
0
0
0
0
118
Annual IC Time Burden (Hours)
52
0
0
0
0
52
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB Justification Memo
0828 83C Justification Memorandum 4-20-2017.docx
04/20/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.