Information Collection

User Fee Payment Refund Request --Form FDA 3913

IC 218309 under ICR 201509-0910-009 · OMB 0910-0805.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0805 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form FDA 3913 User Fee Payment Refund Request --Form FDA 3913	Form
Form FDA 3913 User Fee Payment Refund Request Form_3913.pdf	Form

IC Title:

User Fee Payment Refund Request --Form FDA 3913

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	Form FDA 3913	User Fee Payment Refund Request	Form_3913.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: 1,700

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,700	1,700
Annual IC Time Burden (Hours)	680	680
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.