Assessment Questionnaire

Small Dispensers Assessment Under the Drug Supply Chain Security Act

Documents and Forms

Document Name Document Type
SmallDispensersAssessment_AttachmentC_Questionnaire_11.2025.docx Other-Questionnaire
SmallDispensersAssessment_AttachmentA_Invitation_11.2025.docx Invitation email IC Document

Information Collection (IC) Details

IC Title:	Assessment Questionnaire	Agency IC Tracking Number:	CDER

Is this a Common Form? No		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-Questionnaire			SmallDispensersAssessment_AttachmentC_Questionnaire_11.2025.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 922	Number of Respondents for Small Entity: 922

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	922	922
Annual IC Time Burden (Hours)	2,305	2,305
Annual IC Cost Burden (Dollars)	150,415	150,415

Documents for IC

Title	Document	Date Uploaded
Invitation email	SmallDispensersAssessment_AttachmentA_Invitation_11.2025.docx	11/20/2025

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