Information Collection

Screener and Main Study

IC 256440 under ICR 202305-0910-004 · OMB 0910-0908.

Documents and Forms

Documents and forms in this information collection
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
Final Questionnaire tracked changes May 2023.docx	Other-Questionnaire (tracked changes
Final Questionnaire tracked changes May 2023.docx	Other-Questionnaire (tracked changes
Final Questionnaire Final CLEAN May 2023.docx	Other-Questionnaire (clean)
Final Questionnaire Final CLEAN May 2023.docx	Other-Questionnaire (clean)

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Questionnaire	Targeted MOA Study Questionnaire 10-14-22 final.docx	Yes	Yes	Fillable Fileable
Other-Questionnaire (tracked changes)	Final Questionnaire tracked changes May 2023.docx	Yes	Yes	Fillable Fileable
Other-Questionnaire (clean)	Final Questionnaire Final CLEAN May 2023.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 %

table that charts list of burden
	Approved	Previously Approved
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

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.