Information Collection

Self-Administered Surveys - Study Screener

IC 237299 under ICR 201908-0910-004 · OMB 0910-0876.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0876 can be found here:

Documents and Forms

Document Name Document Type
Quick Turnaround Template.doc Other-Template

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Self-Administered Surveys - Study Screener	Agency IC Tracking Number:	CFSAN

IC Status: New

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-Template			Quick Turnaround Template.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	75,000	75,000
Annual IC Time Burden (Hours)	6,225	6,225
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.