Information Collection

Survey response

IC 246739 under ICR 202103-3041-001 · OMB 3041-0186.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey_Instrument.pdf	Other-Survey Questionnaire
Survey_Instrument.pdf	Other-Survey Questionnaire
CPSC Sleep Warnings Consent Form.pdf Consent Form	IC Document

IC Title:

Survey response

Agency IC Tracking Number:

Is this a Common Form? No

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-Survey Questionnaire			Survey_Instrument.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 650

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	650	650
Annual IC Time Burden (Hours)	163	163
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent Form	CPSC Sleep Warnings Consent Form.pdf	07/09/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.