Information Collection

Formative Research Study to Understand the Impact of Generic Substitutes for Various Patient and Caregiver Populations

IC 236673 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⚠️ Notice: This information collection may be referencing outdated material.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
Appendix A - Youth Generic Screener.docx	Other-Youth Screener
Appendix B - Parental Permission Form.docx	Other-Parental Permission Form
Appendix C - Adult Screener.docx	Other-Adult Screener
Appendix D - Recruitment Confirmation and Reminder Emails.docx	Other-Confirmation and Reminder Emai
Appendix E - Adult Consent Form.docx	Other-Adult Consent Form
Appendix F -Youth Assent Form.docx	Other-Youth Assent Form
Appendix G- Worksheet.docx	Other-Worksheet
Appendix H - Moderator Guide.docx	Other-Moderator Guide
Appendix I - Certificate of Confidentiality.pdf	Other-Cert. of Confidentiality
0695 OMB Approval Memo Impact of Generic Substitutes 2019.docx OMB Approval Memo	IC Document

IC Title:

Formative Research Study to Understand the Impact of Generic Substitutes for Various Patient and Caregiver Populations

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-Youth Screener	Appendix A - Youth Generic Screener.docx	Yes	No	Paper Only
Other-Parental Permission Form	Appendix B - Parental Permission Form.docx	Yes	No	Paper Only
Other-Adult Screener	Appendix C - Adult Screener.docx	Yes	No	Paper Only
Other-Confirmation and Reminder Emails	Appendix D - Recruitment Confirmation and Reminder Emails.docx	Yes	No	Paper Only
Other-Adult Consent Form	Appendix E - Adult Consent Form.docx	Yes	No	Paper Only
Other-Youth Assent Form	Appendix F -Youth Assent Form.docx	Yes	No	Paper Only
Other-Worksheet	Appendix G- Worksheet.docx	Yes	No	Paper Only
Other-Moderator Guide	Appendix H - Moderator Guide.docx	Yes	No	Paper Only
Other-Cert. of Confidentiality	Appendix I - Certificate of Confidentiality.pdf	Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	200	200
Annual IC Time Burden (Hours)	300	300
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 Impact of Generic Substitutes 2019.docx	06/28/2019

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