Informed Consent - Pretest

Healthcare Provider Perception of Boxed Warning Information Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0890 can be found here:

Documents and Forms

Document Name Document Type
Appendix D - Informed Consent- General Practitioners.docx Other-Consent Form - GPs
Appendix D - Informed Consent - Specialist.docx Other-Consent Form
Appendix D - Informed Consent- OB GYN Specialist.docx Other-Consent Form

Information Collection (IC) Details

IC Title:	Informed Consent - Pretest	Agency IC Tracking Number:	CDER

Is this a Common Form? No		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-Consent Form - GPs	Appendix D - Informed Consent- General Practitioners.docx	Yes	Yes	Fillable Fileable
Other-Consent Form	Appendix D - Informed Consent - Specialist.docx	Yes	Yes	Fillable Fileable
Other-Consent Form	Appendix D - Informed Consent- OB GYN Specialist.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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