Information Collection

MedWatch 3500a for use by user-facilities, importers, distributors and manufacturers for MANDATORY reporting

IC 202917 under ICR 201505-0910-002 · OMB 0910-0291.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0291 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA 3500a MedWatch 3500a for use by user-facilities, importers, distributors and manufacturers for MANDATORY reporting	Form and Instruction
FDA 3500a MedWatch (for use by user-facilities, importers, distrib MedWatch 3500a MANDATORY reporting.pdf	Form and Instruction

IC Title:

MedWatch 3500a for use by user-facilities, importers, distributors and manufacturers for MANDATORY reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 301

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
Form and Instruction	FDA 3500a	MedWatch (for use by user-facilities, importers, distributors, and manufacturers for MANDATORY reporting	MedWatch 3500a MANDATORY reporting.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 37,280

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-752,573	752,573
Annual IC Time Burden (Hours)	-835,173	835,173
Annual IC Cost Burden (Dollars)	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.