Information Collection

Patient and Caregiver Diversity in FDA Patient Engagement Activities - Interviews (OC)

IC 249637 under ICR 202206-0910-016 · OMB 0910-0697.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0697 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Interview Guide - Patient Advocacy Organization.docx	Other-Interview Guide - Patient Advo
Interview Guide - Patient Advocacy Organization.docx	Other-Interview Guide - Patient Advo
Invitation Email - Patient Advocacy Organization.docx	Other-Invitation - Patient Advocacy
Invitation Email - Patient Advocacy Organization.docx	Other-Invitation - Patient Advocacy
Screener - Patient Advocacy Organization.docx	Other-Screener - Patient Advocacy Or
Screener - Patient Advocacy Organization.docx	Other-Screener - Patient Advocacy Or
Interview Guide - Patient.docx	Other-Interview Guide - Patient
Interview Guide - Patient.docx	Other-Interview Guide - Patient
Invitation Email - Patient Caregiver.docx	Other-Invitation Email - Patient Car
Invitation Email - Patient Caregiver.docx	Other-Invitation Email - Patient Car
Screener- Patient Caregiver.docx	Other-Screener - Patient Caregiver
Screener- Patient Caregiver.docx	Other-Screener - Patient Caregiver
Consent Form.docx	Other-Consent Form
Consent Form.docx	Other-Consent Form
Patient Flyer.docx	Other-Patient Flyer
Patient Flyer.docx	Other-Patient Flyer
0697 OMB Approval Memo - Patient and Caregiver Diversity 2021.docx OMB Approval Memo	IC Document
0697 OMB Approval Memo - Patient and Caregiver Diversity 2021.docx OMB Approval Memo	IC Document

IC Title:

Patient and Caregiver Diversity in FDA Patient Engagement Activities - Interviews (OC)

Agency IC Tracking Number:

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-Interview Guide - Patient Advocacy Org.	Interview Guide - Patient Advocacy Organization.docx	Yes	No	Printable Only
Other-Invitation - Patient Advocacy Org.	Invitation Email - Patient Advocacy Organization.docx	Yes	No	Printable Only
Other-Screener - Patient Advocacy Org.	Screener - Patient Advocacy Organization.docx	Yes	Yes	Fillable Fileable
Other-Interview Guide - Patient	Interview Guide - Patient.docx	Yes	No	Printable Only
Other-Invitation Email - Patient Caregiver	Invitation Email - Patient Caregiver.docx	Yes	No	Printable Only
Other-Screener - Patient Caregiver	Screener- Patient Caregiver.docx	Yes	Yes	Fillable Fileable
Other-Consent Form	Consent Form.docx	Yes	No	Printable Only
Other-Patient Flyer	Patient Flyer.docx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	40	40
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Approval Memo	0697 OMB Approval Memo - Patient and Caregiver Diversity 2021.docx	10/05/2021

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