Information Collection

Submission of appeal, including request for informal hearing (507.67, 507.69, 507.71)

IC 215363 under ICR 201502-0910-011 · OMB 0910-0789.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0789 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Submission of appeal, including request for informal hearing (507.67, 507.69, 507.71)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 21 CFR 507.67 21 CFR 507.69 21 CFR 507.71

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	132	132

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.