Information Collection

Phase 2: Screener Completes (assumes 90% eligible)

IC 243690 under ICR 202009-0910-009 · OMB 0910-0895.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0895 can be found here:

Documents and Forms

Document Name Document Type
Phase 2 Survey - HCP.pdf Other-HCP Survey
Phase 2 Survey - HCP.pdf Other-HCP Survey
Phase 2 Letters and Postcards - HCP.pdf Other-Letter and Postcards - HCP
Phase 2 Letters and Postcards - HCP.pdf Other-Letter and Postcards - HCP

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Phase 2: Screener Completes (assumes 90% eligible)	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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HCP Survey			Phase 2 Survey - HCP.pdf		Yes	Yes	Fillable Fileable
Other-Letter and Postcards - HCP			Phase 2 Letters and Postcards - HCP.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,180	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	1,180	1,180
Annual IC Time Burden (Hours)	98	98
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.