Information Collection

Number to Complete the Survey (85%) - Study 1

IC 220727 under ICR 201709-0910-007 · OMB 0910-0821.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0821 can be found here:

Documents and Forms

Document Name Document Type
Appendix B - STUDY 1 QUESTIONNAIRE.doc Other-Survey
Appendix A - CONSENT FORM.doc Other-Consent
Appendix D - SCREENER.doc Other-Screener

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Number to Complete the Survey (85%) - Study 1	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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	Appendix B - STUDY 1 QUESTIONNAIRE.doc	Yes	Yes	Fillable Fileable
Other-Consent	Appendix A - CONSENT FORM.doc	Yes	Yes	Fillable Fileable
Other-Screener	Appendix D - SCREENER.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	297	297
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.