Information Collection

Premarket Notification Submission 5100(k), Subpart E

IC 5734 under ICR 200705-0910-004 · OMB 0910-0120.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0120 can be found here:

Documents and Forms

Document Name Document Type
Form 3541 Premarket Notification Submission 5100(k), Subpart E Form and Instruction
3541 Premarket Notification [510 ( K )] Status Request and Re Form FDA 3541.pdf Form and Instruction
3654 Standard Data Report for 519 (K)s Form FDA 3654.pdf Form and Instruction
3514 CDRH Premarket Review Submission Cover Sheet Form FDA 3514.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Premarket Notification Submission 5100(k), Subpart E	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 21 CFR 800.807.87 21 CFR 800.807.81 21 CFR 800.807.92 21 CFR 800.807.93

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3541	Premarket Notification [510 ( K )] Status Request and Response	Form FDA 3541.pdf	Yes	Yes	Fillable Printable
Form and Instruction	3654	Standard Data Report for 519 (K)s	Form FDA 3654.pdf	Yes	Yes	Fillable Printable
Form and Instruction	3514	CDRH Premarket Review Submission Cover Sheet	Form FDA 3514.pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,700	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	26,206	106	26,100
Annual IC Time Burden (Hours)	303,528	-55,472	359,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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