0847 Template

FDA DOCUMENTATION FOR THE GENERIC CLEARANCE

OF REQUEST FOR DATA TO SUPPORT SOCIAL AND BEHAVIORAL RESEARCH (0910-0847)

TITLE OF INFORMATION COLLECTION:

DESCRIPTION OF THIS SPECIFIC COLLECTION

1. Statement of need:

2. Intended use of information:

3. Description of respondents:

4. Date(s) to be conducted:

5. How the information is being collected:

6. Confidentiality of respondents:

7. Amount and justification for any proposed incentive:

8. Questions of a sensitive nature:

9. Description of statistical methods:

BURDEN HOUR COMPUTATION:

Type/Category of Respondent	No. of Respondents	Participation Time (minutes)	Burden (hours)

REQUESTED APPROVAL DATE:

NAME OF PRA ANALYST & PROGRAM CONTACT:

PRA Analyst

Program Contact

FDA CENTER:

1