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Mandatory 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: 192361
OMB.report
HHS/FDA
OMB 0910-0645
ICR 201301-0910-009
IC 192361
( )
⚠️ Notice: This information collection may be referencing outdated material.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
0645_Mandatory_pet_screenshot_3-11-2010[1].doc
Other-Screen Shot
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Mandatory Adverse Event Report via the SRP
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Screen Shot
0645_Mandatory_pet_screenshot_3-11-2010[1].doc
Yes
No
Printable 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:
636
Number of Respondents for Small Entity:
318
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
636
0
0
-127,767
0
128,403
Annual IC Time Burden (Hours)
636
0
0
-127,767
0
128,403
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.