Information Collection

Cognitive Interviews

IC 239524 under ICR 202001-0910-013 · OMB 0910-0885.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0885 can be found here:

Documents and Forms

Document Name Document Type
Appendix B - Cognitive Interviews Consent Form.docx Other-Consent Form
Appendix C - Study 1 Questionnaire.docx Other-Survey Instrument
Appendix D - Study 2 Questionnaire.docx Other-Survey Instrument

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cognitive Interviews	Agency IC Tracking Number:	CDER

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Instrument	Appendix D - Study 2 Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-Consent Form	Appendix B - Cognitive Interviews Consent Form.docx	Yes	Yes	Fillable Fileable
Other-Survey Instrument	Appendix C - Study 1 Questionnaire.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	18	18
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.