Information Collection

Main Study

IC 236002 under ICR 202204-0910-010 · OMB 0910-0872.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0872 can be found here:

Documents and Forms

Document Name Document Type
Appendix A - Consent Form.docx Other-Consent Form
Appendix A - Consent Form.docx Other-Consent Form
Appendix C - Invitation.docx Other-Invitation
Appendix C - Invitation.docx Other-Invitation
Appendix B - Study Questionnaire 2019.docx Other-Questionnaire
Appendix B - Study Questionnaire 2019.docx Other-Questionnaire

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Main Study	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Consent Form	Appendix A - Consent Form.docx	Yes	Yes	Fillable Fileable
Other-Invitation	Appendix C - Invitation.docx	Yes	No	Printable Only
Other-Questionnaire	Appendix B - Study Questionnaire 2019.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 633	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-633	633
Annual IC Time Burden (Hours)	-209	209
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.