Rapid Interviews and Survey of Patients Being Treated with Ambien or Lunesta or their Health Care Professionals

Generic FDA Rapid Response Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0500 can be found here:

Documents and Forms

Document Name Document Type
APPENDIX I INTERVIEW SCRIPT FOR PATIENTS AND CONSUMERS 10-21-14.doc Other-Interview Script
APPENDIX II INTERVIEW SCRIPT FOR HEALTHCARE PROVIDERS AND SUBSCRIBERS 10-21-14.doc Other-Interview Script
0500 OMB JUSTIFICATION MEMO 10-21-14.doc Rapid Response Survey IC Document

Information Collection (IC) Details

IC Title:	Rapid Interviews and Survey of Patients Being Treated with Ambien or Lunesta or their Health Care Professionals	Agency IC Tracking Number:	CDER

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview Script			APPENDIX I INTERVIEW SCRIPT FOR PATIENTS AND CONSUMERS 10-21-14.doc		No		Paper Only
Other-Interview Script			APPENDIX II INTERVIEW SCRIPT FOR HEALTHCARE PROVIDERS AND SUBSCRIBERS 10-21-14.doc		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Rapid Response Survey	0500 OMB JUSTIFICATION MEMO 10-21-14.doc	10/21/2014

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