Information Collection

Screener and study PCPs and Consumers

IC 272787 under ICR 202412-0910-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Adherence Recruitment Materials.docx	Other-Recruitment materials
Adherence Recruitment Materials.docx	Other-Recruitment materials
Adherence Screener.docx	Other-Screener
Adherence Screener.docx	Other-Screener
Adherence Informed Consent.docx	Other-Informed consent
Adherence Informed Consent.docx	Other-Informed consent
Adherence Questionnaire.docx	Other-Questionnaire
Adherence Questionnaire.docx	Other-Questionnaire

IC Title:

Agency IC Tracking Number:

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Recruitment materials	Adherence Recruitment Materials.docx	Yes	Yes	Fillable Fileable
Other-Screener	Adherence Screener.docx	Yes	Yes	Fillable Fileable
Other-Informed consent	Adherence Informed Consent.docx	Yes	Yes	Fillable Fileable
Other-Questionnaire	Adherence Questionnaire.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: 12,584

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	12,584	12,584
Annual IC Time Burden (Hours)	1,293	1,293
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.