Information Collection

Prescription Drug Use Related Software Study (CDER)

IC 250778 under ICR 202206-0910-015 · OMB 0910-0695.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0695 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A - Screeners.docx	Other-Screeners
Appendix A - Screeners.docx	Other-Screeners
Appendix B - Confirmation and Reminder Email.docx	Other-Confirmation and Reminder Emai
Appendix B - Confirmation and Reminder Email.docx	Other-Confirmation and Reminder Emai
Appendix C - Informed Consent.docx	Other-Consent Form
Appendix C - Informed Consent.docx	Other-Consent Form
Appendix D - Moderator Guide.docx	Other-Moderator Guide
Appendix D - Moderator Guide.docx	Other-Moderator Guide
0695 OMB Approval Memo - Prescription Drug Use Related Software 2021.docx OMB Approval Memo	IC Document
0695 OMB Approval Memo - Prescription Drug Use Related Software 2021.docx OMB Approval Memo	IC Document

IC Title:

Prescription Drug Use Related Software Study (CDER)

Agency IC Tracking Number:

CDER

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screeners	Appendix A - Screeners.docx	Yes	Yes	Fillable Fileable
Other-Confirmation and Reminder Emails	Appendix B - Confirmation and Reminder Email.docx	Yes	No	Printable Only
Other-Consent Form	Appendix C - Informed Consent.docx	Yes	No	Printable Only
Other-Moderator Guide	Appendix D - Moderator Guide.docx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 186

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	186	186
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Approval Memo	0695 OMB Approval Memo - Prescription Drug Use Related Software 2021.docx	12/14/2021

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