Information Collection

Cognitive Interview Screener (telephone and mail)

IC 5955 under ICR 202407-0910-012 · OMB 0910-0345.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0345 Phone Prenotification letter.doc	Other-lettter
0345 Address based mailings.docx	Other-screener
Cognitive Interview Screener_FSANS Food Safety Survey-090425.docx	Other-Screener
Cognitive Interview Screener_FSANS Nutrition Survey-090425.docx	Other-Screener

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-lettter	0345 Phone Prenotification letter.doc	Yes	No	Paper Only
Other-screener	0345 Address based mailings.docx	Yes	No	Paper Only
Other-Screener	Cognitive Interview Screener_FSANS Food Safety Survey-090425.docx	Yes	Yes	Fillable Fileable
Other-Screener	Cognitive Interview Screener_FSANS Nutrition Survey-090425.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	6	6
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.