Electronic Submission of FDA Adverse Event Reports and Other Safety Information Using the Electronic Submission Gateway and the Safety Reporting Portal

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FDA 1932a Veterinary Adverse Drug Reaction, Lack of Effectiveness or Product Defect Report	Form	Removed	Available
Form FDA 1932 Veterinary Adverse Drug Reaction, Lack of Effectiveness, Product Defect Report	Form and Instruction	Modified	Available
Form FDA 1932a Veterinary Adverse Drug Reaction, Lack of Effectiveness or Product Defect Report	Form	Removed	Available
Form FDA 1932a Veterinary Adverse Drug Reaction, Lack of Effectiveness or Product Defect Report	Form and Instruction	Removed	Available
Form FDA 1932 Veterinary Adverse Drug Reaction, Lack of Effectiveness, Product Defect Report	Form and Instruction	Removed	Repair queued
0645 SS A 2013 Update.doc	Supporting Statement A	Uploaded 2013-04-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192365	Early Warning Recall Voluntary	Other-system screenshot	Removed
192364	Reportable Food (human and animal) Voluntary View	Form	Removed	Veterinary Adverse Drug Reaction, Lack of Effectiveness or Product Defect Report
192364	Reportable Food (human and animal) Voluntary View	Other-system screenshot	Removed
192363	Reportable Food (human and animal) Mandatory View	Other-guidance document	Modified
192363	Reportable Food (human and animal) Mandatory View	Form and Instruction	Modified	Veterinary Adverse Drug Reaction, Lack of Effectiveness, Product Defect Report
192362	Mandatory Adverse Event Reporting via ESG		Modified
192361	Mandatory Adverse Event Reporting via the SRP	Other-Screen shots for CVM collection	Modified
192360	Voluntary Adverse Event Reporting via the SRP	Other-Screen Shots for CTP Submissions	Modified
189650	Early Warning Recall Voluntary View	Form	Removed	Veterinary Adverse Drug Reaction, Lack of Effectiveness or Product Defect Report
189649	Reportable Food (human and animal) Voluntary View	Form and Instruction	Removed	Veterinary Adverse Drug Reaction, Lack of Effectiveness or Product Defect Report
189649	Reportable Food (human and animal) Voluntary View	Other-guidance	Removed
189648	Reportable Food (human and animal) Mandatory View	Form and Instruction	Removed	Veterinary Adverse Drug Reaction, Lack of Effectiveness, Product Defect Report
189648	Reportable Food (human and animal) Mandatory View	Other-screenshots	Removed
189647	Mandatory View Using Direct Gateway-to Gateway Transmission	Other-screenshots	Removed
189646	Mandatory View Using MedWatch Plus Rational Questionnaire	Other-screenshots	Removed
189645	Voluntary View	Other-screenshots	Removed

ICR Details

OMB Control No: 0910-0645	ICR Reference No: 201302-0910-006
Status: Historical Active	Previous ICR Reference No: 201003-0910-004
Agency/Subagency: HHS/FDA	Agency Tracking No: 18920
Title: Electronic Submission of FDA Adverse Event Reports and Other Safety Information Using the Electronic Submission Gateway and the Safety Reporting Portal
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/30/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/26/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2016	36 Months From Approved	04/30/2013
Responses	1,494,577	0	1,365,042
Time Burden (Hours)	897,001	0	462,318
Cost Burden (Dollars)	0	0	0

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Abstract: This ICR collects both mandatory and voluntary information regarding adverse events associated with FDA-regulated products that are submitted electronically using agency data-collection applications. Because the agency continues to move from a paper/manual submissions process for reporting adverse events to an electronic systems process, the scope of the ICR is limited to those product areas for which an electronic portal has been developed. Respondents include both manufacturers and distributers of FDA products, as well as individual consumers. The information collected enables FDA to identify potential public health threats and implement mitigation strategies as appropriate.

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Authorizing Statute(s): US Code: 21 USC 355 Name of Law: FFDCA
   US Code: 21 USC 357 Name of Law: FFDCA
   US Code: 21 USC 360 Name of Law: FFDCA
   US Code: 21 USC 393 Name of Law: FFDCA
   US Code: 21 USC 301 Name of Law: FFDCA
   PL: Pub.L. 109 - 462 120 Name of Law: DSNDCPA
   PL: Pub.L. 110 - 85 1005 Name of Law: FDAAA
  

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
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 56847	09/14/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 3433	01/16/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Early Warning Recall Voluntary
Early Warning Recall Voluntary View	FDA 1932a	Veterinary Adverse Drug Reaction, Lack of Effectiveness or Product Defect Report
Mandatory Adverse Event Reporting via ESG
Mandatory Adverse Event Reporting via the SRP
Mandatory View Using Direct Gateway-to Gateway Transmission
Mandatory View Using MedWatch Plus Rational Questionnaire
Reportable Food (human and animal) Mandatory View	FDA 1932	Veterinary Adverse Drug Reaction, Lack of Effectiveness, Product Defect Report
Reportable Food (human and animal) Mandatory View	FDA 1932	Veterinary Adverse Drug Reaction, Lack of Effectiveness, Product Defect Report
Reportable Food (human and animal) Voluntary View	FDA 1932a	Veterinary Adverse Drug Reaction, Lack of Effectiveness or Product Defect Report
Reportable Food (human and animal) Voluntary View	FDA 1932a	Veterinary Adverse Drug Reaction, Lack of Effectiveness or Product Defect Report
Voluntary Adverse Event Reporting via the SRP
Voluntary View

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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	1,494,577	1,365,042	0	293,354	-163,819	0
Annual Time Burden (Hours)	897,001	462,318	0	584,081	-149,398	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Program change reductions reflect the removal of duplicative IC entries; program increases are the result of electronic reporting now developed for tobacco products not previously included in electronic reporting program, and the consolidation of reporting burden from 0910-0709.

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Annual Cost to Federal Government: $28,401,010

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? No

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: 02/26/2013

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