| Part A: Check-In Photo Interview |
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Unique ID: |
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| Please tell me why you selected the pictures on the Screener. |
Please tell me why you selected the pictures on the Screener. |
| Female Selection |
Photo # |
Explanation |
Male Selection |
Photo # |
Explanation |
| FEMALE BEST 1 |
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MALE BEST 1 |
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| FEMALE BEST 2 |
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MALE BEST 2 |
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| FEMALE BEST 3 |
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MALE BEST 3 |
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| FEMALE WORST 1 |
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MALE WORST 1 |
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| FEMALE WORST 2 |
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MALE WORST 2 |
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| FEMALE WORST 3 |
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MALE WORST 3 |
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| Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated |
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| to average 10 minutes per response to complete (the time estimated to read and complete). |
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| Send comments regarding this burden estimate or any other aspects of this information collection, including suggestions |
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| for reducing burden, to PRAStaff@fda.hhs.gov. |
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