Information Collection

Feedback web-survey on forensic toxicology testing

IC 243039 under ICR 201902-0920-022 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1050 Feedback web-survey on forensic toxicology testing	Form and Instruction
Att_1a_Screenshot Customer Feedback_cl.docx	Other-Screenshot
0920-1050 Customer Feedback Forensic Toxicology Att_1_ Customer Feedback_cl.docx	Form and Instruction
1050_Request_Forenscis_Tox_Service.docx Request for Approval	IC Document
Att_2_Invitation_email_cl.docx Att 2_Invitational E-mail	IC Document
Att_3_Privacy Applicability.pdf Att 3_Privacy Applicability	IC Document

IC Title:

Feedback web-survey on forensic toxicology testing

Agency IC Tracking Number:

0920-1050-20RA

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
Form and Instruction	0920-1050	Customer Feedback Forensic Toxicology	Att_1_ Customer Feedback_cl.docx		Yes	Yes	Fillable Fileable
Other-Screenshot			Att_1a_Screenshot Customer Feedback_cl.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,618

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	3,618	3,618
Annual IC Time Burden (Hours)	922	922
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	1050_Request_Forenscis_Tox_Service.docx	08/05/2020
Att 2_Invitational E-mail	Att_2_Invitation_email_cl.docx	08/05/2020
Att 3_Privacy Applicability	Att_3_Privacy Applicability.pdf	08/05/2020

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