Information Collection

Screening and survey - Regulatory Science and Innovation B12 Pediatric Device

IC 258779 under ICR 202408-0910-001 · OMB 0910-0912.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CERSI online script.docx	Other-Survey script-online
CERSI phone script.docx	Other-Survey script-phone

IC Title:

Agency IC Tracking Number:

CDRH

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-Survey script-online			CERSI online script.docx		Yes	Yes	Fillable Fileable
Other-Survey script-phone			CERSI phone script.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: 73

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	73	73
Annual IC Time Burden (Hours)	65	65
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.