Information Collection

SCORE Survey

IC 272106 under ICR 202411-0720-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NCR SCORE Survey Instrument.pdf	Other-Survey

IC Title:

SCORE Survey

Agency IC Tracking Number:

0720-SCOR

Is this a Common Form? No

IC Status: New

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			NCR SCORE Survey Instrument.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: SCORE Survey

FR Citation: 89 FR 43836

Number of Respondents: 6,873

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	6,873	6,873
Annual IC Time Burden (Hours)	1,718	1,718
Annual IC Cost Burden (Dollars)	84,315	84,315

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.