Information Collection

Companies providing information on 6-10 drug products

IC 179901 under ICR 200704-3084-003 · OMB 3084-0140.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Brand Name Proposed Special Orders.pdf	Other-Order to File Special Report
Generic Proposed Special Orders.pdf	Other-Order to File Special Report
Authorized Generic Proposed Special Orders.pdf	Other-Order to File Special Report
Sample spreadsheet to Brand Name Drug Companies.pdf	Other-Sample spreadsheet to Brand Na
Sample spreadhseet to Generic Drug Companies.pdf	Other-Sample spreadsheet to Generic
Sample spreadsheet to Authorized Generic Drug Companies.pdf	Other-Sample spreadsheet to Authoriz

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Sample spreadsheet to Authorized Generic Drug Companies	Sample spreadsheet to Authorized Generic Drug Companies.pdf	Yes	Yes	Fillable Fileable
Other-Order to File Special Report	Brand Name Proposed Special Orders.pdf	Yes	Yes	Fillable Fileable
Other-Order to File Special Report	Generic Proposed Special Orders.pdf	Yes	Yes	Fillable Fileable
Other-Order to File Special Report	Authorized Generic Proposed Special Orders.pdf	Yes	Yes	Fillable Fileable
Other-Sample spreadsheet to Brand Name Drug Companies	Sample spreadsheet to Brand Name Drug Companies.pdf	Yes	Yes	Fillable Fileable
Other-Sample spreadsheet to Generic Drug Companies	Sample spreadhseet to Generic Drug Companies.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	4,600	4,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.