Information Collection

Study: Adults (Ages 26+)

IC 233740 under ICR 201810-0910-014 · OMB 0910-0873.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
6. Expressed Claims Questionnaire_OMB.docx	Other-Expressed Claims Questionnaire
Advertisement Images.pdf	Other-Advertisement Images
Package Images.pdf	Other-Package Images

IC Title:

Agency IC Tracking Number:

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Advertisement Images	Advertisement Images.pdf	Yes	No	Printable Only
Other-Package Images	Package Images.pdf	Yes	No	Printable Only
Other-Expressed Claims Questionnaire	6. Expressed Claims Questionnaire_OMB.docx	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,300	3,300
Annual IC Time Burden (Hours)	1,089	1,089
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.