Information Collection

Naloxone Label Comprehension Questionnaire to Optimize the Drug Facts Label (Task 3 - Adolescents)

IC 230838 under ICR 201712-0910-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

table that charts list of instruments
Document Type	Instrument File	Available 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

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,120	1,120
Annual IC Time Burden (Hours)	163	163
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.