Information Collection

Drug Experience Report (on Effects Of Drug Usage)

IC 109268 under ICR 197711-0910-003 · OMB 0910-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0002 can be found here:

Documents and Forms

Document Name Document Type

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Information Collection (IC) Details

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IC Title:	DRUG EXPERIENCE REPORT (ON EFFECTS OF DRUG USAGE)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FD-1639				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	Previously Approved
Annual Number of Responses for this IC	15,000	-25,000	40,000
Annual IC Time Burden (Hours)	7,500	-172,500	180,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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