Information Collection

Biosimilars Prescribing Survey

IC 238395 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⚠️ Notice: This information collection may be referencing outdated material.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
Biosimilars Survey Questionaire.docx	Other-Survey Instrument
Screening Questions.docx	Other-Screening Questions
Informed Consent.docx	Other-Informed Consent
0695 OMB Justification Memo Biosimilars Prescribing 2019 .docx OMB Justification Memo	IC Document

IC Title:

Biosimilars Prescribing Survey

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-Survey Instrument	Biosimilars Survey Questionaire.docx	Yes	Yes	Fillable Fileable
Other-Screening Questions	Screening Questions.docx	Yes	Yes	Fillable Fileable
Other-Informed Consent	Informed Consent.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	500	500
Annual IC Time Burden (Hours)	210	210
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification Memo	0695 OMB Justification Memo Biosimilars Prescribing 2019 .docx	11/04/2019

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