Form 3728 Animal Generic Drug User Fee Cover Sheet

Implementation of the Animal Generic Drug User Fee Act of 2008; User Fee Cover Sheet Form FDA 3728 ( 21 U.S.C. 379j - 21)

Form FDA 3728

Implementation of the Animal Generic Drug User Fee Act of 2008; User Fee Cover Sheet Form FDA 3728

OMB: 0910-0632

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Form Approved: OMB No. 0910-0632 Expiration Date: 06/30/09 See instructions for OMB Statement.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOOD AND DRUG ADMINISTRATION

ANIMAL GENERIC DRUG
USER FEE COVER SHEET

PAYMENT IDENTIFICATION NUMBER (Write the Payment Identification Number on your check)

AG2000003-953877
A completed cover sheet must accompany each original application subject to fees. If payment is sent by U.S. mail or courier, please include a copy of this completed
form with payment. Payment and mailing instructions can be found at: http://www.fda.gov/oc/adufa/agdufacoversheet.html.

1. SPONSOR NAME AND ADDRESS (Include name, street
address, city, state, country, and post office code)

2. CONTACT NAME
ROBERT GUNDERSON

IVX ANIMAL HEALTH INC

3915 SOUTH 48TH ST TERR
ST JOSEPH MO 64503
US

2.1 E-MAIL ADDRESS
[email protected]
2.2. TELEPHONE NUMBER (Include Area Code)
816-676-6185

1.1 EMPLOYER IDENTIFICATION NUMBER (EIN)

2.3 FACSIMILE (FAX) NUMBER (Include Area Code)

431558386

816-676-6873

3. TYPE OF PREMARKET APPLICATION (Select one of the following in each column; if you are unsure, please refer to the
application descriptions at the following website: http://www.fda.gov/oc/adufa/agdufamain.html)
3.1 Application Type
[X] Original Abbreviated New Animal Drug Application (ANADA) - under provisions of 512(b)(2) of the FFDCA
4. IS THIS NEW APPLICATION COVERED BY THE FOLLOWING USER FEE WAIVER? IF SO, CHECK THE APPLICABLE
SECTION.*
[ ] The sole purpose of the application is to support conditions of use for minor use or minor species [741(d)]. This waiver request
has been approved and the FDA waiver number is

5. USER FEE PAYMENT AMOUNT FOR THIS APPLICATION
$41,400.00
*Note to section 4 above: Unless a waiver or reduction has been previously granted by the Agency for this application,
payment is expected pending the outcome of the waiver or reduction decision.

Public Reporting Burden
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instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to:
Department of Health and Human Services
Food and Drug Administration
Office of Chief Information Officer (HFA-710)
5600 Fishers Lane
Rockville, MD 20857
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Form FDA 3728 (11/08)


File Typeapplication/pdf
File TitleForm Approved: OMB No
Authorkimberly.karakorn
File Modified2009-06-11
File Created2009-03-27

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