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Naloxone Label Comprehension Questionnaire to Optimize the Drug Facts Label (Task 3 - Adolescents)
Data to Support Drug Product Communications
OMB: 0910-0695
IC ID: 230838
OMB.report
HHS/FDA
OMB 0910-0695
ICR 201712-0910-001
IC 230838
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0695 can be found here:
2024-03-07 - Extension without change of a currently approved collection
2022-06-30 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Attachment B3 - Telephone Screener.docx
Other-Telephone Screener
Attachment C3 Structured Interview Guide.doc
Other-Interview Guide
Attachment J3 Closing Script and Contact Information Sheet.docx
Other-Script and Contact Information
Attachment K2 Parental Permission Form.docx
Other-Permission Form
Attachment K3 Assent Form.docx
Other-Assent Form
Attachment L1 Injector Spine Label.pdf
Other-Injector Label
Attachment L2 Nasal Supine Label.pdf
Other-Nasal Label
0695 OMB Approval Memo CONFER Study - Adolescents (Task 3).doc
OMB approval memo
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Naloxone Label Comprehension Questionnaire to Optimize the Drug Facts Label (Task 3 - Adolescents)
Agency IC Tracking Number:
CDER
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Telephone Screener
Attachment B3 - Telephone Screener.docx
No
Paper Only
Other-Interview Guide
Attachment C3 Structured Interview Guide.doc
No
Paper Only
Other-Script and Contact Information Sheets
Attachment J3 Closing Script and Contact Information Sheet.docx
No
Paper Only
Other-Permission Form
Attachment K2 Parental Permission Form.docx
No
Paper Only
Other-Assent Form
Attachment K3 Assent Form.docx
No
Paper Only
Other-Injector Label
Attachment L1 Injector Spine Label.pdf
No
Paper Only
Other-Nasal Label
Attachment L2 Nasal Supine Label.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,120
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,120
0
1,120
0
0
0
Annual IC Time Burden (Hours)
163
0
163
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB approval memo
0695 OMB Approval Memo CONFER Study - Adolescents (Task 3).doc
03/28/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.