Information Collection

Submission of additional data elements required by section 417 of the FD&C Act

IC 202325 under ICR 201205-0910-005 · OMB 0910-0709.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
5 scenarios.pdf	Other-screenshots
RFR proposed SRP modifications_12April12.doc RFR proposed SRP modifications_12April12	IC Document
FSMA-Notification-04-30-2012+16_21.pdf FSMA-Notification-04-30-2012+16_21	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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
Other-screenshots			5 scenarios.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,877

Number of Respondents for Small Entity: 190

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	1,877	1,877
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RFR proposed SRP modifications_12April12	RFR proposed SRP modifications_12April12.doc	05/16/2012
FSMA-Notification-04-30-2012+16_21	FSMA-Notification-04-30-2012+16_21.pdf	05/16/2012

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