Information Collection

Panel Replenishment Baseline and Enrollment Survey

IC 216701 under ICR 201903-0910-010 · OMB 0910-0815.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0815 can be found here:

Documents and Forms

Document Name Document Type
Attachment_3_Respondent_Materials_English_CLEAN.pdf Other-Respondent Materials - English
Attachment_4_Respondent_Materials_Spanish_CLEAN.pdf Other-Respondent Materials - Spanish

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Panel Replenishment Baseline and Enrollment Survey	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-Respondent Materials - English			Attachment_3_Respondent_Materials_English_CLEAN.pdf		No		Printable Only
Other-Respondent Materials - Spanish			Attachment_4_Respondent_Materials_Spanish_CLEAN.pdf		No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,650	-198	1,848
Annual IC Time Burden (Hours)	826	364	462
Annual IC Cost Burden (Dollars)	0	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.