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Consumer Fact Sheet and Website Outreach Card on Medication Use during Pregnancy
Focus Groups as Used by the Food and Drug Administration
OMB: 0910-0497
IC ID: 215494
OMB.report
HHS/FDA
OMB 0910-0497
ICR 201406-0910-019
IC 215494
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0497 can be found here:
2023-10-31 - Extension without change of a currently approved collection
2020-10-02 - Extension without change of a currently approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Consumer Fact Sheet and Website Outreach Card on Medication Use during Pregnancy
Agency IC Tracking Number:
OC
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted 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
Federal Enterprise Architecture Business Reference Module
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 %
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
32
0
32
0
0
0
Annual IC Time Burden (Hours)
64
0
64
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.