OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Adverse Event Reporting Follow-up Survey

IC 7729 under ICR 200810-0935-002 · OMB 0935-0125.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Adverse Event Reporting Follow-up Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #1 Questionnaire -- Mailed Version Attachment A -- Risk Manager Questionnaire -- Mail Version.doc No No Paper Only
Form and Instruction Form #2 Questionnaire -- Telephone Version Attachment B -- Risk Manager Questionnaire -- Phone Version.doc No No Paper Only

Health Consumer Health and Safety

 

1,020 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 1,020 0 1,020 0 0 0
Annual IC Time Burden (Hours) 425 0 425 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment C -- Questionnaire Cover Letter Attachment C -- Questionnaire Cover Letter.doc 10/06/2008
Attachment D -- Reminder Post Card Attachment D -- Reminder Post Card.doc 10/06/2008
Attachment E -- Remail Cover Letter Attachment E -- Remail Cover Letter.doc 10/06/2008
Attachment F -- Phone Survey Intro Script Attachment F -- Phone Survey Intro Script.doc 10/06/2008
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.