OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Healthcare Study

IC 246366 under ICR 202103-0910-011 · OMB 0910-0896.

Documents and Forms
Document Name
Document Type
Other-Survey Instrument
Other-Survey Instrument
Other-Recruitment Script
Other-Recruitment Script
Other-List of Drug Names
Other-List of Drug Names
Other-Consent
Other-Consent
Information Collection (IC) Details

View Information Collection (IC)

Healthcare Study CDER
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL 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

Health Consumer Health and Safety

 

493 0
   
Individuals or Households
 
   100 %

  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 493 0 493 0 0 0
Annual IC Time Burden (Hours) 163 0 163 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.