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Malfunction report (21 CFR 4.103(b)(2))
Postmarketing Safety Reporting for Combination Products
OMB: 0910-0834
IC ID: 191023
OMB.report
HHS/FDA
OMB 0910-0834
ICR 200910-0910-001
IC 191023
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0834 can be found here:
2020-08-31 - Extension without change of a currently approved collection
2017-06-29 - New collection (Request for a new OMB Control Number)
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Malfunction report (21 CFR 4.103(b)(2))
Agency IC Tracking Number:
Is this a Common Form?
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
21 CFR 4.103(b)(2)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
10 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
300
0
300
0
0
0
Annual IC Time Burden (Hours)
450
0
450
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.