Information Collection

Consumer Main Study Screener

IC 232566 under ICR 201808-0910-002 · OMB 0910-0860.

Documents and Forms

Document Name Document Type
Appendix A - Screeners.docx Other-Screeners
Appendix B - Recruitment Forms.docx Recruitment Forms IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Consumer Main Study Screener	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-Screeners			Appendix A - Screeners.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500	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	2,500	2,500
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Recruitment Forms	Appendix B - Recruitment Forms.docx	08/08/2018

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