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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 3756 Form
FDA 3756 - Proof Form FDA 3756 - Proof Form.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.