Companies providing information on 1-5 drug products

[Company]

A
AG Trade
Name, if any

AG Drugs and Information

B
Brand-Name

C
Active Ingredient

D
Dosage
Form

E
NDA #

1

FTC Authorized Generic Drug Study

Page 1 of 2

F
G
H
Dosage 14-digit Generic AG's 9 digit
Strength Product Identifier
NDC #
(Labeler
Code Product
Code)

Questions 4, 5

I
Labeler/Entity Name

OMB Control No. [insert]

[Company]

1

H
AG's 9 digit
NDC #
(Labeler
Code Product
Code)

AG Drugs and Information

J
Date of Launch

FTC Authorized Generic Drug Study

Questions 4, 5

K
L
Date of first
Date of
Discontinuance, if announcement of
AG marketing
any

Page 2 of 2

OMB Control No. [insert]