Information Collection

Cognitive Interview Screener (telephone and mail)

IC 5955 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
0345 Phone Prenotification letter.doc Other-lettter
0345 Address based mailings.docx Other-screener

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cognitive Interview Screener (telephone and mail)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-screener			0345 Address based mailings.docx		Yes	No	Paper Only
Other-lettter			0345 Phone Prenotification letter.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.