Information Collection

CONFER Study; Comprehension of Over-the-Counter Naloxone for Emergency Response

IC 223175 under ICR 201607-0910-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Attachment A_Groups 1-3 screener_v8_clean.pdf Other-Study Screener
Attachment B_Group 4 Screener_v8_clean.pdf Other-Study Screener 2
Attachment C_Provider Information Sheet_clean.pdf Other-Study Document: Provider Info.
Attachment D_Recruitment Flyer_clean.pdf Other-Study Document: Recruitment Fl
Attachment E_Recruitment Palm Card_clean.pdf Other-Study Document: Recruitment Ca
Attachment F_Agreement to Participate bc edits_clean.pdf Other-Study Document: Partipation Ag
Attachment G_Naloxone DFL_clean.pdf Other-Study Document: Sample Drug Fa
Attachment H_Moderator Guide_8 11 16_clean.pdf Other-Study Document: Moderator Guid
0695 CONFER Study Re Nalozone for Emergency Response OMB Approval Request Memo.pdf CONFER OMB Approval Request Memorandum IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CONFER Study; Comprehension of Over-the-Counter Naloxone for Emergency Response	Agency IC Tracking Number:	CDER

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-Study Screener	Attachment A_Groups 1-3 screener_v8_clean.pdf	Yes	Yes	Fillable Fileable
Other-Study Screener 2	Attachment B_Group 4 Screener_v8_clean.pdf	Yes	Yes	Fillable Fileable
Other-Study Document: Provider Info. Sheet	Attachment C_Provider Information Sheet_clean.pdf	Yes	Yes	Fillable Fileable
Other-Study Document: Recruitment Flyer	Attachment D_Recruitment Flyer_clean.pdf	Yes	Yes	Fillable Fileable
Other-Study Document: Recruitment Card	Attachment E_Recruitment Palm Card_clean.pdf	Yes	Yes	Fillable Fileable
Other-Study Document: Partipation Agreement	Attachment F_Agreement to Participate bc edits_clean.pdf	Yes	Yes	Fillable Fileable
Other-Study Document: Sample Drug Facts Label	Attachment G_Naloxone DFL_clean.pdf	Yes	Yes	Fillable Fileable
Other-Study Document: Moderator Guide	Attachment H_Moderator Guide_8 11 16_clean.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,778	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	2,778	2,778
Annual IC Time Burden (Hours)	599	599
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CONFER OMB Approval Request Memorandum	0695 CONFER Study Re Nalozone for Emergency Response OMB Approval Request Memo.pdf	08/24/2016

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