An Exploratory Assessment of Substances Used as Adjuncts or Alternatives to Prescription Opioids

Data To Support Social and Behavioral Research as Used by the Food and Drug Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0847 can be found here:

Documents and Forms

Document Name Document Type
Attachment A - Screener.docx Other-Screener
Appendix B - List of Prescription Opioids.docx Other-List of Prescription Opioids
Appendix C - List of Prescription Benzodiazepines.docx Other-List of Prescription Benzodiaz
Attachment D - Informed Consent Form.docx Other-Consent Form
Attachment E - Reminder Language.docx Other-Reminder
Attachment F - Interview Guide.docx Other-Interview Guide
Certificate of Confidentiality.pdf Other-Certificate of Confidentiality
0847 OMB Approval Memo Exploratory Assessment of Substances Used 2020.docx OMB Approval Memo IC Document

Information Collection (IC) Details

IC Title:	An Exploratory Assessment of Substances Used as Adjuncts or Alternatives to Prescription Opioids	Agency IC Tracking Number:	CDER

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener	Attachment A - Screener.docx	Yes	Yes	Fillable Fileable
Other-List of Prescription Opioids	Appendix B - List of Prescription Opioids.docx	Yes	No	Printable Only
Other-List of Prescription Benzodiazepines	Appendix C - List of Prescription Benzodiazepines.docx	Yes	No	Printable Only
Other-Consent Form	Attachment D - Informed Consent Form.docx	Yes	Yes	Fillable Fileable Signable
Other-Reminder	Attachment E - Reminder Language.docx	Yes	No	Printable Only
Other-Interview Guide	Attachment F - Interview Guide.docx	Yes	No	Printable Only
Other-Certificate of Confidentiality	Certificate of Confidentiality.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 280	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	280	280
Annual IC Time Burden (Hours)	210	210
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Approval Memo	0847 OMB Approval Memo Exploratory Assessment of Substances Used 2020.docx	08/05/2020

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