Information Collection

Survey of "Health Care Providers' Responses to Medical Device Labeling Content

IC 201489 under ICR 201203-0910-001 · OMB 0910-0715.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B - Cover Letter.doc	Other-Cover Letter
Telephone Script for Interviewer.doc	Other-Telephone Script
Attachment A - Questionnaire and Confidentiality Assurance.docx	Other-Survey
Attachment G - Label Version 3.pdf Attachment G - Label Version 3	IC Document
Attachment E - Label Version 1.pdf Attachment E - Label Version 1	IC Document
Attachment F - Label Version 2.pdf Attachment F - Label Version 2	IC Document
Device Label Survey screenshots.doc Device Label Survey screenshots	IC Document
Attachment D - Label Version Table.doc Attachment D - Label Version Table	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 801

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Telephone Script	Telephone Script for Interviewer.doc	No		Paper Only
Other-Survey	Attachment A - Questionnaire and Confidentiality Assurance.docx	Yes	Yes	Fillable Fileable Signable
Other-Cover Letter	Attachment B - Cover Letter.doc	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,248

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, 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	1,248	1,248
Annual IC Time Burden (Hours)	324	324
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment G - Label Version 3	Attachment G - Label Version 3.pdf	03/01/2012
Attachment E - Label Version 1	Attachment E - Label Version 1.pdf	03/01/2012
Attachment F - Label Version 2	Attachment F - Label Version 2.pdf	03/01/2012
Device Label Survey screenshots	Device Label Survey screenshots.doc	03/01/2012
Attachment D - Label Version Table	Attachment D - Label Version Table.doc	07/02/2012

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