Survey

eFiling Beta Pilot Test

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
eFiling Alpha Pilot - Participant Questionnaire - Qualitative Burden.pdf Instruction
eFiling Alpha Pilot - Participant Questionnaire - Quantitative Burden.pdf Instruction
Beta Pilot Survey Questions.docx Other-Electronic survey

Information Collection (IC) Details

IC Title:	Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	eFiling Alpha Pilot - Participant Questionnaire - Qualitative Burden.pdf	Yes	Yes	Printable Only
Instruction	eFiling Alpha Pilot - Participant Questionnaire - Quantitative Burden.pdf	Yes	Yes	Printable Only
Other-Electronic survey	Beta Pilot Survey Questions.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: 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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	110	110
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.