OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 243036 under ICR 202205-0910-005 · OMB 0910-0847.

Documents and Forms
Document Name
Document Type
Other-Screener
Other-Screener
Other-List of Prescription Opioids
Other-List of Prescription Opioids
Other-List of Prescription Benzodiaz
Other-List of Prescription Benzodiaz
Other-Consent Form
Other-Consent Form
Other-Reminder
Other-Reminder
Other-Interview Guide
Other-Interview Guide
Other-Certificate of Confidentiality
Other-Certificate of Confidentiality
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL 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

Health Health Care Services

 

280 0
   
Individuals or Households
 
   0 %

  Requested 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 280 0 0 0 0 280
Annual IC Time Burden (Hours) 210 0 0 0 0 210
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.