Information Collection

MedWatch 3500 for VOLUNTARY reporting of adverse events, product problems and product use errors

IC 5858 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⚠️ Notice: This information collection may be referencing outdated material.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 3500 MedWatch 3500 for VOLUNTARY reporting of adverse events, product problems and product use errors Form and Instruction
FDA 3500 MedWatch for VOLUNTARY reporting of adverse events, prod Medwatch 3500 VOLUNTARY.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MedWatch 3500 for VOLUNTARY reporting of adverse events, product problems and product use errors	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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 3500	MedWatch for VOLUNTARY reporting of adverse events, product problems and product use errors	Medwatch 3500 VOLUNTARY.pdf		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22,700	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 20 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-22,700	22,700
Annual IC Time Burden (Hours)	-13,620	13,620
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.