Healthcare Study

Empirical Study of Promotional Implications of Proprietary Prescription Drug Names

Documents and Forms

Document Name Document Type
Appendix A - Questionnaire.docx Other-Survey Instrument
Appendix A - Questionnaire.docx Other-Survey Instrument
Appendix B - Recruitment Script.docx Other-Recruitment Script
Appendix B - Recruitment Script.docx Other-Recruitment Script
Appendix D - Drug Names.docx Other-List of Drug Names
Appendix D - Drug Names.docx Other-List of Drug Names
Appendix E - Informed Consent.docx Other-Consent
Appendix E - Informed Consent.docx Other-Consent

Information Collection (IC) Details

IC Title:	Healthcare Study	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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Instrument	Appendix A - Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-Recruitment Script	Appendix B - Recruitment Script.docx	Yes	No	Printable Only
Other-List of Drug Names	Appendix D - Drug Names.docx	Yes	No	Printable Only
Other-Consent	Appendix E - Informed Consent.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: 493	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	493	493
Annual IC Time Burden (Hours)	163	163
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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