Surveillance Sampling Outreach Survey

Generic FDA Rapid Response Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0500 can be found here:

Documents and Forms

Document Name Document Type
Appendix A 0500 Surveillance Sampling Outreach Questions 5-2-2016.doc Other-Survey
Appendix B 0500 Potential Respondents 5-2-2016.doc Other-List of Stakeholders
OMB Justification Memo for Surveillance Sampling Outreach.doc OMB Justification Memo for Gen IC Request for Rapid Response IC Document

Information Collection (IC) Details

IC Title:	Surveillance Sampling Outreach Survey	Agency IC Tracking Number:	CFSAN

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-Survey			Appendix A 0500 Surveillance Sampling Outreach Questions 5-2-2016.doc		Yes	Yes	Paper Only
Other-List of Stakeholders			Appendix B 0500 Potential Respondents 5-2-2016.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 275	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	275	275
Annual IC Time Burden (Hours)	550	550
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Justification Memo for Gen IC Request for Rapid Response	OMB Justification Memo for Surveillance Sampling Outreach.doc	05/03/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.