Pretest 1 and 2 Screener

Study of Multiple Indications in Direct-to-Consumer Television Advertisements

Documents and Forms

Document Name Document Type
Appendix B - Screener.docx Other-Screener
Appendix B - Screener.docx Other-Screener
Appendix D - Recruitment Materials.docx Other-Recruitment Materials
Appendix D - Recruitment Materials.docx Other-Recruitment Materials
Appendix A - Consent Form.docx Other-Consent Form
Appendix A - Consent Form.docx Other-Consent Form

Information Collection (IC) Details

IC Title:	Pretest 1 and 2 Screener	Agency IC Tracking Number:	CDER

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener	Appendix B - Screener.docx	Yes	Yes	Fillable Fileable
Other-Recruitment Materials	Appendix D - Recruitment Materials.docx	Yes	No	Printable Only
Other-Consent Form	Appendix A - Consent Form.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: 264	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	264	264
Annual IC Time Burden (Hours)	22	22
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.