Information Collection

App G_Preliminary Survey for Boot Wear Evaluation

IC 221622 under ICR 201906-0920-012 · OMB 0920-1125.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix G.docx	Other-WORD
Appendix M.docx App M_Informed Consent	IC Document

IC Title:

Agency IC Tracking Number:

16GK

Is this a Common Form? No

IC Status: Unchanged

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-WORD			Appendix G.docx		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: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
App M_Informed Consent	Appendix M.docx	05/20/2016

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