OMB Control No. 0910-0847
Expiration Date: 02/28/2026
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0847. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden to [email protected].
Dear (insert name),
We need your help!
Researchers from UCSF and UCLA are conducting a one-time 15-minute survey to understand why people might or might not join research studies. The study we are conducting is on behalf of the U.S. Food and Drug Administration (FDA). Participants will receive a $25 gift card for survey completion. Participation is completely voluntary, and you can withdraw from the study at any time.
You may be eligible for this survey study if:
You are 65 years of age or older and are taking multiple medicines.
The enclosed information sheet has more details about the study. Please contact the research team if you have any questions:
[UCSF participants:] Alveena Thomas at [email protected] or (925) 200-1149
[UCLA participants: Ariga Eyvazi at [email protected] or (310) 794-8242]
You can participate by:
1. Clicking this link [insert survey link] or pasting the URL into your browser to start the survey. This link can only be used by you. OR
2. Contacting the research team at the email address or phone number listed above for more information, to receive a paper copy of the survey, or to complete the survey by telephone.
You may receive up to 2 more emails and a phone call from our research team regarding this study.
If you do not want to receive any further communications from us, click this link [insert opt-out link] or contact the research team at the email address or phone number listed above.
Sincerely,
Janice B. Schwartz, MD
Professor of Medicine, Department of Medicine
University of California, San Francisco
[or Derjung M. Tarn, MD, PhD
Professor of Family Medicine, Department of Family Medicine
David Geffen School of Medicine at UCLA
[Information Sheet will be copied and pasted here]
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Alveena Thomas |
File Modified | 0000-00-00 |
File Created | 2023-11-05 |