CONFER: Comprehension of Over-the-Counter Naloxone for Emergency Response (Task 2 - Adolescents)

IMPROVE Study Phase 2

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0695 can be found here:

Documents and Forms

Document Name Document Type
Attachment C Group 3 Screener Adolescent.docx Other-Study Screener
Attachment C2 Group 3 Closing Script and Contact Info.docx Other-Closing Script and Contact Inf
Attachment E Adolescent Questionnaire.doc Other-Interview Guide
Attachment N Group 3 Parental Permission Form.docx Other-Parental Permission Form
Attachment O Group 3 Assent Form for Adolescents.docx Other-Assent Form
Attachment P Label Version N Injector Supine.pdf Other-Drug Facts Label
Attachment P Label Version N Nasal Supine.pdf Other-Drugs Facts Label
0695 OMB Approval Memo CONFER Study - Adolescents 8-7-2017.doc CONFER OMB approval request memorandum IC Document

Information Collection (IC) Details

IC Title:	CONFER: Comprehension of Over-the-Counter Naloxone for Emergency Response (Task 2 - Adolescents)	Agency IC Tracking Number:	CDER

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-Closing Script and Contact Information	Attachment C2 Group 3 Closing Script and Contact Info.docx	Yes	Yes	Fillable Fileable
Other-Interview Guide	Attachment E Adolescent Questionnaire.doc	Yes	Yes	Fillable Fileable
Other-Parental Permission Form	Attachment N Group 3 Parental Permission Form.docx	Yes	Yes	Fillable Fileable
Other-Assent Form	Attachment O Group 3 Assent Form for Adolescents.docx	Yes	Yes	Fillable Fileable
Other-Drug Facts Label	Attachment P Label Version N Injector Supine.pdf	Yes	Yes	Fillable Fileable
Other-Drugs Facts Label	Attachment P Label Version N Nasal Supine.pdf	Yes	Yes	Fillable Fileable
Other-Study Screener	Attachment C Group 3 Screener Adolescent.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 99	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	99	99
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CONFER OMB approval request memorandum	0695 OMB Approval Memo CONFER Study - Adolescents 8-7-2017.doc	08/07/2017

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