Information Collection

Focus Group Study of Healthcare Provider Knowledge of Biosimilar Biological Products

IC 214408 under ICR 201412-0910-003 · OMB 0910-0687.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Recruitment Screener 11-20-14.doc	Other-Questionnaire
OMB Justification for generic clearance for Focus Group Study of HP Knowledge of BBP 11-20-14.doc OMB Justification for Generic Clearance for Focus Group Study of Healthcare Provider Knowledge of BBP	IC Document
Moderator Guide 11-20-14.doc Moderator Guide	IC Document
Consent Form - Physicians 11-20-14.docx Consent Form - Physician	IC Document
Consent Form - Pharmacists 11-20-14.docx Consent Form - Pharmacists	IC Document
Consent Form - NPs & PAs 11-20-14.docx Consent Form - NP & PA	IC Document
CITI_Lappin_20140917 11-20-14.pdf Training Certificate - Lappin	IC Document
CITI IRB Training Certificate (Scales) 11-20-14.pdf Training Certificate - Scales	IC Document
CITI IRB Training Certificate (Rupert) 11-20-14.pdf Training Certificate - Rupert	IC Document

IC Title:

Agency IC Tracking Number:

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-Questionnaire			Recruitment Screener 11-20-14.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 240

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	240	240
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification for Generic Clearance for Focus Group Study of Healthcare Provider Knowledge of BBP	OMB Justification for generic clearance for Focus Group Study of HP Knowledge of BBP 11-20-14.doc	12/23/2014
Moderator Guide	Moderator Guide 11-20-14.doc	12/23/2014
Consent Form - Physician	Consent Form - Physicians 11-20-14.docx	12/23/2014
Consent Form - Pharmacists	Consent Form - Pharmacists 11-20-14.docx	12/23/2014
Consent Form - NP & PA	Consent Form - NPs & PAs 11-20-14.docx	12/23/2014
Training Certificate - Lappin	CITI_Lappin_20140917 11-20-14.pdf	12/23/2014
Training Certificate - Scales	CITI IRB Training Certificate (Scales) 11-20-14.pdf	12/23/2014
Training Certificate - Rupert	CITI IRB Training Certificate (Rupert) 11-20-14.pdf	12/23/2014

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