Information Collection

Survey

IC 255969 under ICR 202409-3041-001 · OMB 3041-0193.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
eFiling Alpha Pilot - Participant Questionnaire - Qualitative Burden.pdf	Instruction
eFiling Alpha Pilot - Participant Questionnaire - Qualitative Burden.pdf	Instruction
eFiling Alpha Pilot - Participant Questionnaire - Quantitative Burden.pdf	Instruction
eFiling Alpha Pilot - Participant Questionnaire - Quantitative Burden.pdf	Instruction
Beta Pilot Survey Questions.docx	Other-Electronic survey
Beta Pilot Survey Questions.docx	Other-Electronic survey

IC Title:

Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Yes	Yes	Printable Only
Instruction	Yes	Yes	Printable Only
Other-Electronic survey	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 %

table that charts list of burden
	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

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.

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