Information Collection

Screener and Main Study

IC 256440 under ICR 202210-0910-006 · OMB 0910-0908.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0908 can be found here:

Documents and Forms

Document Name Document Type
Targeted MOA Study Questionnaire 10-14-22 final.docx Other-Questionnaire
Targeted MOA Study Questionnaire 10-14-22 final.docx Other-Questionnaire

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Screener and Main Study	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-Questionnaire			Targeted MOA Study Questionnaire 10-14-22 final.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: 990	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	990	990
Annual IC Time Burden (Hours)	891	891
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.