Consent and Screener: Adults (Ages 26+)

Investigation of Consumer Perceptions of Expressed Modified Risk Claims

Documents and Forms

Document Name Document Type
4. Expressed Claims Screener.docx Other-Expressed Claims Screener
5. Expressed Claims Informed Consent.docx Other-Expressed Claims Informed Cons

Information Collection (IC) Details

IC Title:	Consent and Screener: Adults (Ages 26+)	Agency IC Tracking Number:

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-Expressed Claims Screener			4. Expressed Claims Screener.docx		Yes	Yes	Fillable Fileable Signable
Other-Expressed Claims Informed Consent			5. Expressed Claims Informed Consent.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	16,500	16,500
Annual IC Time Burden (Hours)	1,650	1,650
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.