Main Study Screener

Hearing, Aging, and Direct-to-Consumer Television Advertisements

Documents and Forms

Document Name Document Type
Appendix A_Screener and Informed Conset_PretestMain 092515.docx Other-Appendix A - Screener and Info

Information Collection (IC) Details

IC Title:	Main Study Screener	Agency IC Tracking Number:	CDER

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix A - Screener and Informed Consent			Appendix A_Screener and Informed Conset_PretestMain 092515.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: 2,112	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,112	2,112
Annual IC Time Burden (Hours)	169	169
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.