Information Collection

Pretest and Main Study

IC 256443 under ICR 202306-0910-001 · OMB 0910-0910.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screener Text Analysis PDN clean_060123.docx	Other-Screener
Screener Text Analysis PDN clean_060123.docx	Other-Screener
Questionnaire Text Analysis PDN clean_060123.docx	Other-Questionnaire
Questionnaire Text Analysis PDN clean_060123.docx	Other-Questionnaire

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener			Screener Text Analysis PDN clean_060123.docx		Yes	Yes	Fillable Fileable
Other-Questionnaire			Questionnaire Text Analysis PDN clean_060123.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: 1,100

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	1,100	1,100
Annual IC Time Burden (Hours)	374	374
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.