Information Collection

Online Survey

IC 250299 under ICR 202111-3041-001 · OMB 3041-0189.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3041-0189 can be found here:

Documents and Forms

Document Name Document Type
Survey Questionnaire.pdf Other-Survey and stimuli
Survey Questionnaire.pdf Other-Survey and stimuli

Information Collection (IC) Details

View Information Collection (IC)

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:

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

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	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	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
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.