Information Collection

Phase 1: Screener Completes (assumes 30% eligible)

IC 243688 under ICR 202201-0910-008 · OMB 0910-0895.

Documents and Forms

Document Name Document Type
Phase 1 Screener - HCP.pdf Other-Screener - HCP
Phase 1 Screener - HCP.pdf Other-Screener - HCP

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Phase 1: Screener Completes (assumes 30% eligible)	Agency IC Tracking Number:	CDER

Is this a Common Form? No		IC Status: Unchanged

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-Screener - HCP			Phase 1 Screener - HCP.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: 104	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	104	104
Annual IC Time Burden (Hours)	9	9
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.