OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Pretest screener

IC 183122 under ICR 201712-0910-003 · OMB 0910-0545.

Documents and Forms
Document Name
Document Type
Other-Questionnaire
Other-Core questions
Other-Pretest screener
Information Collection (IC) Details

View Information Collection (IC)

Pretest screener
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Questionnaire 0545 Survey Questionnaire.doc Yes Yes Fillable Fileable
Other-Core questions core questions - Health and Diet Survey.doc Yes Yes Fillable Fileable
Other-Pretest screener Health and Diet Survey pretest screener.doc Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

2,000 0
   
Individuals or Households
 
   0 %

  Requested 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 2,000 0 0 0 0 2,000
Annual IC Time Burden (Hours) 66 0 0 0 0 66
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.