Information Collection

CONFER: Comprehension of Over-the-Counter Naloxone for Emergency Response (Task 2 - Adolescents)

IC 227844 under ICR 201701-0910-014 · OMB 0910-0695.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0695 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment C Group 3 Screener Adolescent.docx	Other-Study Screener
Attachment C2 Group 3 Closing Script and Contact Info.docx	Other-Closing Script and Contact Inf
Attachment E Adolescent Questionnaire.doc	Other-Interview Guide
Attachment N Group 3 Parental Permission Form.docx	Other-Parental Permission Form
Attachment O Group 3 Assent Form for Adolescents.docx	Other-Assent Form
Attachment P Label Version N Injector Supine.pdf	Other-Drug Facts Label
Attachment P Label Version N Nasal Supine.pdf	Other-Drugs Facts Label
0695 OMB Approval Memo CONFER Study - Adolescents 8-7-2017.doc CONFER OMB approval request memorandum	IC Document

IC Title:

CONFER: Comprehension of Over-the-Counter Naloxone for Emergency Response (Task 2 - Adolescents)

Agency IC Tracking Number:

CDER

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-Closing Script and Contact Information	Attachment C2 Group 3 Closing Script and Contact Info.docx	Yes	Yes	Fillable Fileable
Other-Interview Guide	Attachment E Adolescent Questionnaire.doc	Yes	Yes	Fillable Fileable
Other-Parental Permission Form	Attachment N Group 3 Parental Permission Form.docx	Yes	Yes	Fillable Fileable
Other-Assent Form	Attachment O Group 3 Assent Form for Adolescents.docx	Yes	Yes	Fillable Fileable
Other-Drug Facts Label	Attachment P Label Version N Injector Supine.pdf	Yes	Yes	Fillable Fileable
Other-Drugs Facts Label	Attachment P Label Version N Nasal Supine.pdf	Yes	Yes	Fillable Fileable
Other-Study Screener	Attachment C Group 3 Screener Adolescent.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 99

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	99	99
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CONFER OMB approval request memorandum	0695 OMB Approval Memo CONFER Study - Adolescents 8-7-2017.doc	08/07/2017

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