Information Collection

Mandatory Adverse Event Report via the SRP

IC 192361 under ICR 201301-0910-009 · OMB 0910-0645.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0645 can be found here:

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

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	636	-127,767	128,403
Annual IC Time Burden (Hours)	636	-127,767	128,403
Annual IC Cost Burden (Dollars)	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.