Information Collection

All Centers - Form 3500B (Consumer Reporting)

IC 216812 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form FDA 3500B All Centers - Form 3500B (Consumer Reporting) Form and Instruction
FDA 3500B MedWatch Consumer Reporting FDA-3500B.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	All Centers - Form 3500B (Consumer Reporting)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 301

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDA 3500B	MedWatch Consumer Reporting	FDA-3500B.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,750	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,750	13,750
Annual IC Time Burden (Hours)	6,325	6,325
Annual IC Cost Burden (Dollars)	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.