Premarket Notification Submission 5100(k), Subpart E

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FDA 3654 Standards Data Report for 510(k)s	Form and Instruction	Modified	Available
Form FDA 3541 Premarket Notification 510(K)	Form and Instruction	Modified	Available
Form FDA 3514 CDRH Premarket Review Submission Cover Sheet	Form and Instruction	Modified	Available
eCopy Guidance.doc	Supplementary Document	Uploaded 2012-12-12	Available
eCopy 83c 0910-0120 12-12-12.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2012-12-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5734	Premarket Notification Submission 5100(k), Subpart E	Form and Instruction	Modified	Standards Data Report for 510(k)s
5734	Premarket Notification Submission 5100(k), Subpart E	Form and Instruction	Modified	Premarket Notification 510(K)
5734	Premarket Notification Submission 5100(k), Subpart E	Form and Instruction	Modified	CDRH Premarket Review Submission Cover Sheet

ICR Details

OMB Control No: 0910-0120	ICR Reference No: 201212-0910-005
Status: Historical Active	Previous ICR Reference No: 201008-0910-006
Agency/Subagency: HHS/FDA	Agency Tracking No:
Title: Premarket Notification Submission 5100(k), Subpart E
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/17/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/12/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2013	12/31/2013	12/31/2013
Responses	9,474	0	9,474
Time Burden (Hours)	336,233	0	336,233
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection requires a person who intends to market a medical device to submit premarket notification submission to FDA as least 90 days before proposing to begin the introduction, or delivery for introduction into interstate commerce, for commercial distribution of a device intended for human use. The information collected in a premarket notification allows for scientific and/or medical review of devices, subject to section 510(k) of the act, to confirm that the new devices are as safe and as effective as legally marketed predicate devices.

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Authorizing Statute(s): US Code: 21 USC 510
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Premarket Notification Submission 5100(k), Subpart E	FDA 3514, FDA 3541, FDA 3654	CDRH Premarket Review Submission Cover Sheet ,   Premarket Notification 510(K) ,   Standards Data Report for 510(k)s

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	9,474	9,474	0	0	0	0
Annual Time Burden (Hours)	336,233	336,233	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $26,591,400

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/12/2012

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