Information Collection

Online survey

IC 250235 under ICR 202105-3041-001 · OMB 3041-0188.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey Questionnaire.pdf	Other-Survey and stimuli
Survey Questionnaire.pdf	Other-Survey and stimuli
MockUpOfControlNumber_InFocusStimuli.pdf	Other-Survey and stimuli

IC Title:

Online survey

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 and stimuli			Survey Questionnaire.pdf		Yes	Yes	Fillable Fileable
Other-Survey and stimuli			MockUpOfControlNumber_InFocusStimuli.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: 750

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	750	750
Annual IC Time Burden (Hours)	188	188
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.