Healthcare Professional Pretest Screener

Disclosures in Professional and Consumer Prescription Drug Promotion

Documents and Forms

Document Name Document Type
Appendix A - Screeners.docx Other-Screeners
Appendix B - Recruitment Forms.docx Recruitment Forms IC Document

Information Collection (IC) Details

IC Title:	Healthcare Professional Pretest Screener	Agency IC Tracking Number:	CDER

Is this a Common Form? No		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-Screeners			Appendix A - Screeners.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 735	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	735	735
Annual IC Time Burden (Hours)	22	22
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Recruitment Forms	Appendix B - Recruitment Forms.docx	08/08/2018

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