Information Collection

Certificate of Identity - FDA Form 3975

IC 226535 under ICR 201704-0910-012 · OMB 0910-0832.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0832 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3975 Certificate of Identity Certificate of Identity - FDA Form 3975	Form
3975 Certificate of Identity FORM FDA 3975 4-25-2017.docx	Form

IC Title:

Certificate of Identity - FDA Form 3975

Agency IC Tracking Number:

ORA

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 20 and 21

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	3975				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 3

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	10	10
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.

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