Information Collection

Pharmacist Survey Completes

IC 216608 under ICR 201505-0910-003 · OMB 0910-0801.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix 1. National Survey of Pharmacists About Pill Appearance.doc	Other-National Survey of Pharmacists
Appendix 4. Pharmacist Survey Alert Letter Example.docx	Other-Pharmacist Survey Alert Letter
Appendix 5. Pharmacist Survey Cover Letter.doc	Other-Pharmacist Survey Cover Letter
Appendix 8. Pharmacist Survey Intro Online Survey.docx	Other-Pharmacist Survey Intro Online
Appendix 6. Pharmacist Survey Reminder Letter 1.docx	Other-Pharmacist Survey Reminder Let
Appendix 7. Pharmacist Survey Reminder Letter 2.doc	Other-Pharmacist Survey Reminder Let

IC Title:

Agency IC Tracking Number:

CDER

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-National Survey of Pharmacists About Pill Appearance	Appendix 1. National Survey of Pharmacists About Pill Appearance.doc	Yes	Yes	Fillable Fileable Signable
Other-Pharmacist Survey Alert Letter	Appendix 4. Pharmacist Survey Alert Letter Example.docx	Yes	Yes	Fillable Fileable Signable
Other-Pharmacist Survey Cover Letter	Appendix 5. Pharmacist Survey Cover Letter.doc	Yes	Yes	Fillable Fileable Signable
Other-Pharmacist Survey Intro Online Survey	Appendix 8. Pharmacist Survey Intro Online Survey.docx	Yes	Yes	Fillable Fileable Signable
Other-Pharmacist Survey Reminder Letter 1	Appendix 6. Pharmacist Survey Reminder Letter 1.docx	Yes	Yes	Fillable Fileable Signable
Other-Pharmacist Survey Reminder Letter 2	Appendix 7. Pharmacist Survey Reminder Letter 2.doc	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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