Information Collection

Self-Administered Surveys

IC 237300 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Quick Turnaround Template.doc	Other-Template

IC Title:

Self-Administered Surveys

Agency IC Tracking Number:

CFSAN

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
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: 15,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	3,750	3,750
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.