Information Collection

Healthcare Professional Interviews: Data Disclosures in Communications About Prescription Drugs

IC 238253 under ICR 201712-0910-001 · OMB 0910-0695.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Appendix A-Email_Screener_Invitation Oncologists.docx Other-Email, Screener, and Invitatio
Appendix B-Email_Screener_Invitation PCPs.docx Other-Email, Screener, and Invitatio
Appendix C - Confirmation Email Letter.docx Other-Confirmation email
Appendix D - Informed Consent.docx Other-Informed Consents
Appendix E - Reminder Email.docx Other-Reminder email
Appendix F - Remote Interview Guide.docx Other-Interview Guide
0695 OMB Approval Memo-Data Disclosures 2019.docx
OMB Approval Memo
IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Email, Screener, and Invitation for Oncologists Appendix A-Email_Screener_Invitation Oncologists.docx Yes Yes Fillable Fileable
Other-Email, Screener, and Invitation for PCPs Appendix B-Email_Screener_Invitation PCPs.docx Yes Yes Fillable Fileable
Other-Confirmation email Appendix C - Confirmation Email Letter.docx Yes Yes Printable Only
Other-Informed Consents Appendix D - Informed Consent.docx Yes Yes Fillable Fileable
Other-Reminder email Appendix E - Reminder Email.docx Yes Yes Printable Only
Other-Interview Guide Appendix F - Remote Interview Guide.docx Yes No Printable Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 140 0 140 0 0 0
Annual IC Time Burden (Hours) 87 0 87 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
OMB Approval Memo 0695 OMB Approval Memo-Data Disclosures 2019.docx 10/23/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.