Information Collection

Rapid Interviews and Survey of Patients Being Treated with Ambien or Lunesta or their Health Care Professionals

IC 213536 under ICR 201404-0910-010 · OMB 0910-0500.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0500 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
APPENDIX I INTERVIEW SCRIPT FOR PATIENTS AND CONSUMERS 10-21-14.doc	Other-Interview Script
APPENDIX II INTERVIEW SCRIPT FOR HEALTHCARE PROVIDERS AND SUBSCRIBERS 10-21-14.doc	Other-Interview Script
0500 OMB JUSTIFICATION MEMO 10-21-14.doc Rapid Response Survey	IC Document

IC Title:

Rapid Interviews and Survey of Patients Being Treated with Ambien or Lunesta or their Health Care Professionals

Agency IC Tracking Number:

CDER

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview Script			APPENDIX I INTERVIEW SCRIPT FOR PATIENTS AND CONSUMERS 10-21-14.doc		No		Paper Only
Other-Interview Script			APPENDIX II INTERVIEW SCRIPT FOR HEALTHCARE PROVIDERS AND SUBSCRIBERS 10-21-14.doc		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Rapid Response Survey	0500 OMB JUSTIFICATION MEMO 10-21-14.doc	10/21/2014

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