Character Spaced Study

Character-Space-Limited Online Prescription Drug Communications

Documents and Forms

Document Name Document Type
Appendix B - Questionnaire.docx Other-Survey
Appendix A -- consent form.docx Other-Consent Form
Appendix C -- recruitment email.docx Other-Recruitment Emails

Information Collection (IC) Details

IC Title:	Character Spaced Study	Agency IC Tracking Number:	CDER

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	Appendix B - Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-Consent Form	Appendix A -- consent form.docx	Yes	No	Paper Only
Other-Recruitment Emails	Appendix C -- recruitment email.docx	Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,502	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,502	6,502
Annual IC Time Burden (Hours)	1,128	1,128
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.