Information Collection

Survey on Usage and Functionality of Smoke Alarms and Carbon Monoxide Alarms (SCOA) in US Households In-Home Administration

IC 232007 under ICR 202106-3041-001 · OMB 3041-0180.

Documents and Forms

Document Name Document Type
Appendix G to H - In-Home Survey and Abbreviated Survey.pdf Other-Survey
Appendix A - Door Hanger.pdf Appendix A: Door Hanger IC Document
Appendix B to C - Consent Form and Waiver.pdf Appendix B-C: Consent Form and Waiver IC Document
Appendix D - Thank You Email.pdf Appendix D: Thank You Email IC Document
Appendix E to F - Explanation of Study and FAQs.pdf Appendix E-F: Explanation of Study and FAQs IC Document
Appendix I to L - Press Release, Advertisements, and Website Text.pdf Appendix I-L: Press Release, Advertisements, and Website Text IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey on Usage and Functionality of Smoke Alarms and Carbon Monoxide Alarms (SCOA) in US Households In-Home Administration	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 G to H - In-Home Survey and Abbreviated Survey.pdf		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,185	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,185	100	1,085
Annual IC Time Burden (Hours)	1,552	467	1,085
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix A: Door Hanger	Appendix A - Door Hanger.pdf	10/28/2021
Appendix B-C: Consent Form and Waiver	Appendix B to C - Consent Form and Waiver.pdf	10/28/2021
Appendix D: Thank You Email	Appendix D - Thank You Email.pdf	10/28/2021
Appendix E-F: Explanation of Study and FAQs	Appendix E to F - Explanation of Study and FAQs.pdf	10/28/2021
Appendix I-L: Press Release, Advertisements, and Website Text	Appendix I to L - Press Release, Advertisements, and Website Text.pdf	10/28/2021

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