Information Collection

Poison Help General Population Survey

IC 198611 under ICR 201709-0915-001 · OMB 0915-0343.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Poison Help General Population Survey	Form
1 Appendix B - General Population Survey.docx Appendix B - General Population Survey.docx	Form
2 Appendix C - General Population Survey Screener.docx Appendix C - General Population Survey Screener.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Appendix B - General Population Survey.docx	Appendix B - General Population Survey.docx		No		Paper Only
Form	2	Appendix C - General Population Survey Screener.docx	Appendix C - General Population Survey Screener.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,600	4,600
Annual IC Time Burden (Hours)	374	374
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.