Information Collection

Submission of Form FDA 3958

IC 183429 under ICR 201706-0910-011 · OMB 0910-0621.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0621 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3958 Submission of Form FDA 3958	Form and Instruction
0621 Food Regulatory Program Standards.pdf	Other-Program Standards
3958 FDA National Registry Report 0621 Form FDA 3958.pdf	Form and Instruction

IC Title:

Submission of Form FDA 3958

Agency IC Tracking Number:

CFSAN

Is this a Common Form? No

IC Status: Modified

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 and Instruction	3958	FDA National Registry Report	0621 Form FDA 3958.pdf		Yes	Yes	Fillable Fileable Signable
Other-Program Standards			0621 Food Regulatory Program Standards.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	50	50
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.