APPLICATION FOR COMMISSION (STATE OFFICIALS TO ACT AS AGENTS FOR FDA)

ICR 197511-0910-002

OMB: 0910-0010

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
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ICR Details
0910-0010 197511-0910-002
Historical Active 197510-0910-003
HHS/FDA
APPLICATION FOR COMMISSION (STATE OFFICIALS TO ACT AS AGENTS FOR FDA)
Extension without change of a currently approved collection   No
Regular
Approved without change 11/11/1975
Retrieve Notice of Action (NOA) 11/11/1975
  Inventory as of this Action Requested Previously Approved
11/30/1980 11/30/1980 11/30/1980
200 0 200
200 0 200
0 0 0

THIS IS USED TO OBTAIN BACKGROUND INFORMATION ON STATE OFFICIALS APPLYING FOR AN FDA COMMISSION TO ACT AS AGENTS OF FDA PERFORMING CERTAIN FUNCTIONS OBLIGATORY TO THE FEDERAL FOOD, DRUG AND COSMETIC ACT.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR COMMISSION (STATE OFFICIALS TO ACT AS AGENTS FOR FDA) FD-1777

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 200 200 0 0 0 0
Annual Time Burden (Hours) 200 200 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/11/1975


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