Generic FDA Rapid Response Surveys

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0500_Template.doc	Supplementary Document	Uploaded 2017-06-30	Available
0500_summary_Surveillance Sampling Outreach Survey.doc	Supplementary Document	Uploaded 2017-06-30	Available
0500_summary_Rapid Response Survey for Hepatitis E Virus-Exposure Blood Donors.doc	Supplementary Document	Uploaded 2017-06-30	Available
0500_Summary_Rapid Interviews and Survey of Patients Being Treated with Ambien or Lunesta or their Health Care Professionals .doc	Supplementary Document	Uploaded 2017-06-30	Available
0500_summary_Babesia-Exposure Rapid Survey of Blood Donors.doc	Supplementary Document	Uploaded 2017-06-30	Available
0500_SS_B_6-15-2017.doc	Supporting Statement B	Uploaded 2017-06-15	Available
0500_SS_A_6-15-2017.doc	Supporting Statement A	Uploaded 2017-06-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
232454	Surveillance Sampling Outreach	Other-Survey	New

ICR Details

OMB Control No: 0910-0500	ICR Reference No: 201706-0910-010
Status: Historical Active	Previous ICR Reference No: 201404-0910-010
Agency/Subagency: HHS/FDA	Agency Tracking No: Generic
Title: Generic FDA Rapid Response Surveys
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/18/2017
	Date Received in OIRA: 06/30/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2020	36 Months From Approved	09/30/2017
Responses	60,000	0	60,000
Time Burden (Hours)	30,000	0	30,000
Cost Burden (Dollars)	0	0	0

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Abstract: This program will obtain data on safety information to support quick-turnaround decision-making about potential safety problems or risk management solutions. This information will be collected from health professionals, hospitals, and other user facilities (e.g., nursing homes, ambulatory surgical facilities and outpatient diagnostic and treatment facilities, etc.), consumers, sponsors and manufacturers of biologics, drugs and medical products, distributors, and importers when FDA must quickly determine whether or not a problem with a medical product impacts the public health.

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Authorizing Statute(s): US Code: 21 USC 355 Name of Law: FD&C Act
   US Code: 21 USC 360 Name of Law: Federal Food, Drug, and Cosmetic Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 4354	01/13/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 28074	06/20/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Surveillance Sampling Outreach

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	60,000	60,000	0	0	0	0
Annual Time Burden (Hours)	30,000	30,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/30/2017

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