Information Collection

Reporting - Requirement for Foreign Establishment or U.S. Agent to Report Changes in U.S. Agents Name Address of Telephone Number Within 10 Business Days of Change

IC 193012 under ICR 201005-0910-010 · OMB 0910-0625.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0625 can be found here:

Documents and Forms

Document Name Document Type
Form 3673 Reporting - Requirement for Foreign Establishment or U.S. Agent to Report Changes in U.S. Agents Name Address of Telephone Number Within 10 Business Days of Change Form and Instruction
3673 Device Registration & Listing Module Form FDA 3673 Device Regs & Liasting Module.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Reporting - Requirement for Foreign Establishment or U.S. Agent to Report Changes in U.S. Agents Name Address of Telephone Number Within 10 Business Days of Change	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 807.40 (b)(3)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3673	Device Registration & Listing Module	Form FDA 3673 Device Regs & Liasting Module.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,836	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 99 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	1,836	1,836
Annual IC Time Burden (Hours)	459	459
Annual IC Cost Burden (Dollars)	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.