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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cannabis Questions
Agency IC Tracking Number:
0920-0222-21GG
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
Form and Instruction
0920-21GG
Screener
Att 4a 4b- Cannabis Telephone Screening Script.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-21GG
Question Provenance
Cannabis OMB Attachment 2_Question Provenance.docx
No
Fillable Fileable
Form and Instruction
0920-21GG
Questionnaire
Cannabis OMB Attachment 1_Questionnaire.docx
No
Fillable Fileable
Form and Instruction
0920-21GG
Data Collection Sheet
Cannabis OMB Attachment 6a 6b_Data Collection Sheet.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-21GG
Follow Up Interview
Cannabis OMB Attachment 8_Follow Up Interview.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
540
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
540
0
540
0
0
0
Annual IC Time Burden (Hours)
122
0
122
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Cannabis 10-day-letter
Cannabis 10-day-letter 07302021.docx
08/04/2021
Table of Jurisdictions
Cannabis OMB Attachment 9_Table of Jurisdictions.docx
08/04/2021
Thank You Letter
Cannabis OMB Attachment 7_Thank You Letter.docx
08/04/2021
Advertisements
Cannabis OMB Attachment 3a 3b_Advertisements.docx
08/04/2021
Informed Consent
Cannabis OMB Attachment 5a 5b_Informed Consent.docx
08/04/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.