Information Collection

Number to Complete the Screener (10%) - Study 2

IC 220729 under ICR 201804-0910-011 · OMB 0910-0821.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix D - SCREENER.doc	Other-Screener
Appendix E - RECRUITMENT EMAILS.doc Recruitment Emails	IC Document

IC Title:

Agency IC Tracking Number:

CDER

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
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: 1,513

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	Previously Approved
Annual Number of Responses for this IC	1,513	1,513
Annual IC Time Burden (Hours)	76	76
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Recruitment Emails	Appendix E - RECRUITMENT EMAILS.doc	03/24/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.