Information Collection

Study 1

IC 236700 under ICR 202001-0910-014 · OMB 0910-0874.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Questionnaires.docx	Other-Survey Instrument
Consent Form - Study 1.docx	Other-Consent Form - Study 1

IC Title:

Study 1

Agency IC Tracking Number:

CDER

Is this a Common Form? No

IC Status: Modified

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-Survey Instrument			Questionnaires.docx		Yes	Yes	Fillable Fileable
Other-Consent Form - Study 1			Consent Form - Study 1.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: 2,105

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,105	2,105
Annual IC Time Burden (Hours)	2,800	2,800
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.