Information Collection

Healthcare Professional Main Study Screener

IC 232572 under ICR 201808-0910-002 · OMB 0910-0860.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A - Screeners.docx	Other-Screeners
Appendix B - Recruitment Forms.docx Recruitment Forms	IC Document

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-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: 2,206

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	2,206	2,206
Annual IC Time Burden (Hours)	66	66
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.