Main Study Screener

Disclosure Regarding Additional Risks in Direct-to-Consumer Prescription Drug Television Advertisements

Documents and Forms

Document Name Document Type
0785 Questionnaire Revised 10-15-2015.docx Other-Questionnaire

Information Collection (IC) Details

IC Title:	Main Study Screener	Agency IC Tracking Number:	CDER

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 202.1(e)(5)(i) 21 CFR 202.1(e)(3)(ii) 21 CFR 202.1(e)(6)(i)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire			0785 Questionnaire Revised 10-15-2015.docx		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: 15,032	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15,032	15,032
Annual IC Time Burden (Hours)	451	451
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.