Information Collection

Form 3756

IC 195930 under ICR 201101-0910-005 · OMB 0910-0680.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0680 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3756	Form
FDA 3756 - Proof Form FDA 3756 - Proof Form.pdf	Form

IC Title:

Form 3756

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	FDA 3756 - Proof Form	FDA 3756 - Proof Form.pdf		No	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.