View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Rapid Message Testing with Consumers - Paxlovid Information CDER
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Patient eligibility screening checklist 0695 PAXLOVID Patient Eligibility Screening Checklist and Drug Interaction Tool 7-20-22.pdf Yes No Fillable Printable
Other-Website content 0695 Paxlovid QA Website Content 7-20-22.docx Yes No Printable Only
Other-Screener 0695 Paxlovid Screener 7-20-22.docx Yes Yes Fillable Fileable
Other-Interview guide 0695 Paxlovid Interview Guide Paxlovid 7-20-22.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

325 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 325 0 325 0 0 0
Annual IC Time Burden (Hours) 29 0 29 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
0695 OMB Memo: Paxlovid 0695 OMB memo Paxlovid 7-20-22.docx 07/20/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.