View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	CFSAN Adverse Event Reporting System (CAERS) Healthcare Provider (HCP) In-Depth Interviews (Formative Research)	Agency IC Tracking Number:	CFSAN

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-Screener			0891 APP I Interview Screener CAERS HCP FINAL.docx		Yes	Yes	Fillable Fileable
Other-Interview guide			0891 APP III Interview Guide CAERS HCP FINAL.docx		Yes	Yes	Fillable Fileable
Other-Informed consent			0891 APP II Informed Consent CAERS HCP FINAL.docx		Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 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	45	0	45	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

Documents for IC

Title	Document	Date Uploaded
OMB Memo / Abbreviated Supporting Statement	0891 OMB Memo CAERS.docx	05/19/2023

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