Information Collection

Main Study Screener

IC 236800 under ICR 202006-0910-002 · OMB 0910-0875.

Documents and Forms

Document Name Document Type
APPENDIX A screener.docx Other-Screener
APPENDIX C recruitment materials.docx Other-Recruitment Materials

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Main Study Screener	Agency IC Tracking Number:	CDER

Is this a Common Form? No		IC Status: Modified

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-Screener			APPENDIX A screener.docx		Yes	No	Printable Only
Other-Recruitment Materials			APPENDIX C recruitment materials.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	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	Previously Approved
Annual Number of Responses for this IC	1,200	500	700
Annual IC Time Burden (Hours)	36	15	21
Annual IC Cost Burden (Dollars)	0	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.