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Voluntary Adverse Event Report via the SRP
Electronic Data Collection Using MedWatchPlus Portal and Rational Questionnaire--21 CFR 310.305, 314.80, 314.98, 514.80, 600.80, 1271.350 and Part 803
OMB: 0910-0645
IC ID: 192360
OMB.report
HHS/FDA
OMB 0910-0645
ICR 201301-0910-009
IC 192360
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0645 can be found here:
2021-09-14 - No material or nonsubstantive change to a currently approved collection
2020-05-14 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 3800
Voluntary Adverse Event Report via the SRP
Form
RFR proposed SRP modifications_12April12.doc
Other-Table of Changes to Registry
3800 Safety Reporting Portal
CTP SRP Report Wireframes 11192012.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Voluntary Adverse Event Report via the SRP
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
3800
Safety Reporting Portal
CTP SRP Report Wireframes 11192012.pdf
Yes
Yes
Fillable Fileable
Other-Table of Changes to Registry
RFR proposed SRP modifications_12April12.doc
Yes
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,513
Number of Respondents for Small Entity:
757
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,513
0
0
-36,052
0
37,565
Annual IC Time Burden (Hours)
908
0
0
-21,631
0
22,539
Annual IC Cost Burden (Dollars)
0
0
0
0
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.