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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.