Information Collection

Consumer Fact Sheet and Website Outreach Card on Medication Use during Pregnancy

IC 215494 under ICR 201406-0910-019 · OMB 0910-0497.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0497 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Medication and Pregnancy Moderator Guide 1_28_15.doc	Instruction
Medication and Pregnancy Screener Guide_DRAFT_12_1_14.doc	Instruction
Pregnancy Focus Group Consent Form FINAL 12_19_14.docx	Other-Consent Form
Pregnancy Focus Group_Fact Sheet Check FINAL 12_19_14 (4).docx	Other-Fact Sheet
FDA OWH Medicine and Pregnancy Focus Groups - OMB 0910-0497.doc Focus Group Supporting Statement	IC Document

IC Title:

Consumer Fact Sheet and Website Outreach Card on Medication Use during Pregnancy

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Instruction	Medication and Pregnancy Moderator Guide 1_28_15.doc	No	Printable Only
Instruction	Medication and Pregnancy Screener Guide_DRAFT_12_1_14.doc	No	Printable Only
Other-Consent Form	Pregnancy Focus Group Consent Form FINAL 12_19_14.docx	No	Printable Only
Other-Fact Sheet	Pregnancy Focus Group_Fact Sheet Check FINAL 12_19_14 (4).docx	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32

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	32	32
Annual IC Time Burden (Hours)	64	64
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Focus Group Supporting Statement	FDA OWH Medicine and Pregnancy Focus Groups - OMB 0910-0497.doc	03/02/2015

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