Information Collection

Pretest Screener (phone and mail); Pretest (phone and mail); Survey Screener (phone and mail); Phone Survey; Mail Survey

IC 190818 under ICR 201808-0910-007 · OMB 0910-0345.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0345 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0345 survey script.xlsx	Other-survey script

IC Title:

Pretest Screener (phone and mail); Pretest (phone and mail); Survey Screener (phone and mail); Phone Survey; Mail Survey

Agency IC Tracking Number:

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-survey script			0345 survey script.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 66,265

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	66,265	66,265
Annual IC Time Burden (Hours)	2,845	2,845
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.