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Federal forms, ICRs, and supporting documents

Information Collection

Formative Research Study to Understand the Impact of Generic Substitutes for Various Patient and Caregiver Populations

IC 236673 under ICR 201712-0910-001 · OMB 0910-0695.

Documents and Forms
Document Name
Document Type
Other-Youth Screener
Other-Parental Permission Form
Other-Adult Screener
Other-Confirmation and Reminder Emai
Other-Adult Consent Form
Other-Youth Assent Form
Other-Worksheet
Other-Moderator Guide
Other-Cert. of Confidentiality
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Formative Research Study to Understand the Impact of Generic Substitutes for Various Patient and Caregiver Populations CDER
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Youth Screener Appendix A - Youth Generic Screener.docx Yes No Paper Only
Other-Parental Permission Form Appendix B - Parental Permission Form.docx Yes No Paper Only
Other-Adult Screener Appendix C - Adult Screener.docx Yes No Paper Only
Other-Confirmation and Reminder Emails Appendix D - Recruitment Confirmation and Reminder Emails.docx Yes No Paper Only
Other-Adult Consent Form Appendix E - Adult Consent Form.docx Yes No Paper Only
Other-Youth Assent Form Appendix F -Youth Assent Form.docx Yes No Paper Only
Other-Worksheet Appendix G- Worksheet.docx Yes No Paper Only
Other-Moderator Guide Appendix H - Moderator Guide.docx Yes No Paper Only
Other-Cert. of Confidentiality Appendix I - Certificate of Confidentiality.pdf Yes No Paper Only

Health Consumer Health and Safety

 

200 0
   
Individuals or Households
 
   0 %

  Approved 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 200 0 200 0 0 0
Annual IC Time Burden (Hours) 300 0 300 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
OMB Approval Memo 0695 OMB Approval Memo Impact of Generic Substitutes 2019.docx 06/28/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.