Screener, Pretest and Main Study: Consumers and Primary Care Physicians

Perceptions of Prescription Drug Products with Medication Tracking Capabilities

Documents and Forms

Document Name Document Type
Appendix A - Questionnaire FINAL.docx Other-Questionnaire
Appendix A - Questionnaire FINAL.docx Other-Questionnaire
SSB Med Tracking FINAL.docx Other-Screener
SSB Med Tracking FINAL.docx Other-Screener
Appendix C - Informed Consent FINAL.docx Other-Informed consent
Appendix C - Informed Consent FINAL.docx Other-Informed consent

Information Collection (IC) Details

IC Title:	Screener, Pretest and Main Study: Consumers and Primary Care Physicians	Agency IC Tracking Number:	CDER

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire	Appendix A - Questionnaire FINAL.docx	Yes	Yes	Fillable Fileable
Other-Screener	SSB Med Tracking FINAL.docx	Yes	Yes	Fillable Fileable
Other-Informed consent	Appendix C - Informed Consent FINAL.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: 1,360	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,360	1,360
Annual IC Time Burden (Hours)	373	373
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.