Information Collection

Filing Entry-Line

IC 255970 under ICR 202209-3041-001 · OMB 3041-0193.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3041-0193 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Beta Pilot PRA Supporting Statement.pdf	Instruction
Beta Pilot PRA Supporting Statement.pdf	Instruction

IC Title:

Filing Entry-Line

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Instruction			Beta Pilot PRA Supporting Statement.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 5

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,132,500	1,132,500
Annual IC Time Burden (Hours)	3,600	3,600
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.