Information Collection

Pilot study completes

IC 228626 under ICR 201710-0910-003 · OMB 0910-0849.

Documents and Forms

Documents and forms in this information collection
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

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	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: 600

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	600	600
Annual IC Time Burden (Hours)	200	200
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.