Information Collection

Main study screener completes

IC 228625 under ICR 201710-0910-003 · OMB 0910-0849.

Documents and Forms

Document Name Document Type
Claim ID Study 1 Pretest Questionnaire_for distribution.pdf Other-Study 1 Survey
Claim ID Study 2 Pretest Questionnaire_for distribution.pdf Other-Study 2 Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Main study screener completes	Agency IC Tracking Number:	CDER

Is this a Common Form? No		IC Status: New

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-Study 1 Survey			Claim ID Study 1 Pretest Questionnaire_for distribution.pdf		Yes	Yes	Fillable Fileable
Other-Study 2 Survey			Claim ID Study 2 Pretest Questionnaire_for distribution.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,031	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,031	14,031
Annual IC Time Burden (Hours)	468	468
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.