Information Collection

Survey on Usage and Functionality of Smoke Alarms and Carbon Monoxide Alarms (SCOA) in US Households In-Home Administration

IC 232007 under ICR 202106-3041-001 · OMB 3041-0180.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix G to H - In-Home Survey and Abbreviated Survey.pdf	Other-Survey
Appendix G to H - In-Home Survey and Abbreviated Survey.pdf	Other-Survey
Appendix A - Door Hanger.pdf Appendix A: Door Hanger	IC Document
Appendix A - Door Hanger.pdf Appendix A: Door Hanger	IC Document
Appendix B to C - Consent Form and Waiver.pdf Appendix B-C: Consent Form and Waiver	IC Document
Appendix B to C - Consent Form and Waiver.pdf Appendix B-C: Consent Form and Waiver	IC Document
Appendix D - Thank You Email.pdf Appendix D: Thank You Email	IC Document
Appendix D - Thank You Email.pdf Appendix D: Thank You Email	IC Document
Appendix E to F - Explanation of Study and FAQs.pdf Appendix E-F: Explanation of Study and FAQs	IC Document
Appendix E to F - Explanation of Study and FAQs.pdf Appendix E-F: Explanation of Study and FAQs	IC Document
Appendix I to L - Press Release, Advertisements, and Website Text.pdf Appendix I-L: Press Release, Advertisements, and Website Text	IC Document
Appendix I to L - Press Release, Advertisements, and Website Text.pdf Appendix I-L: Press Release, Advertisements, and Website Text	IC Document

IC Title:

Agency IC Tracking Number:

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					No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,185

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,185	100	1,085
Annual IC Time Burden (Hours)	1,552	467	1,085
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix A: Door Hanger		10/28/2021
Appendix B-C: Consent Form and Waiver		10/28/2021
Appendix D: Thank You Email		10/28/2021
Appendix E-F: Explanation of Study and FAQs		10/28/2021
Appendix I-L: Press Release, Advertisements, and Website Text		10/28/2021

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

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