OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

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

Documents and Forms
Document Name
Document Type
Other-Interview Guide - Patient Advo
Other-Interview Guide - Patient Advo
Other-Invitation - Patient Advocacy
Other-Invitation - Patient Advocacy
Other-Screener - Patient Advocacy Or
Other-Screener - Patient Advocacy Or
Other-Interview Guide - Patient
Other-Interview Guide - Patient
Other-Invitation Email - Patient Car
Other-Invitation Email - Patient Car
Other-Screener - Patient Caregiver
Other-Screener - Patient Caregiver
Other-Consent Form
Other-Consent Form
Other-Patient Flyer
Other-Patient Flyer
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL 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

Health Consumer Health and Safety

 

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

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.