Information Collection

Biosimilars Prescribing Survey

IC 236850 under ICR 201712-0910-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Screening Questions.docx Other-Screening Questions
Informed Consent.docx Other-Consent Form
Biosimilars Survey Questionaire.docx Other-Survey Instrument
0695 OMB Approval Memo for Biosimilars Prescribing 2019.doc OMB Approval Memo IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Biosimilars Prescribing Survey	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-Screening Questions	Screening Questions.docx	Yes	Yes	Fillable Fileable
Other-Consent Form	Informed Consent.docx	Yes	Yes	Fillable Fileable
Other-Survey Instrument	Biosimilars Survey Questionaire.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	210	210
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Approval Memo	0695 OMB Approval Memo for Biosimilars Prescribing 2019.doc	07/10/2019

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