FDA Rapid Response Survey Streamlined Gen IC Memo ATTACHMENT D

FDA DOCUMENTATION FOR THE GENERIC CLEARANCE

OF RAPID RESPONSE SURVEYS (0910-0500)

FDA uses the Rapid Response Surveys to further develop tools and science necessary to better understand where vulnerabilities are and the most effective ways to minimize them, as well as to intervene and respond once a problem occurs.

TITLE OF INFORMATION COLLECTION: [insert]

DESCRIPTION OF THIS SPECIFIC COLLECTION

1. What is the problem to be investigated:

[insert]

2. Please describe the method to obtain the convenience sample:

[insert]

3. Are there any deviations to the described methods, procedures, and uses of data contained in the Rapid Response Survey 2011 Justification Statement:

YES / NO (if no skip to #5)

[insert]

4. If yes, please describe:

[insert]

5. Burden Chart and Description:

[insert]

BURDEN HOUR COMPUTATION (Number of responses (X) estimated response or participation time in minutes (/60) = annual burden hours):

Type/Category of Respondent	No. of Respondents	Participation Time (minutes)	Burden (hours)

6. Attach Questions

REQUESTED APPROVAL DATE: [insert]

NAME OF PRA ANALYST & PROGRAM CONTACT: [insert]

FDA CENTER: [insert]

1