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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
0645_Mandatory_pet_screenshot_3-11-2010[1].doc	Other-Screen Shot

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.