Information Collection

Sample to accompany request (21 CFR 80.22)

IC 182948 under ICR 201708-0910-013 · OMB 0910-0216.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0216 can be found here:

Documents and Forms

Document Name Document Type
Form 3000 Sample to accompany request (21 CFR 80.22) Form and Instruction
Form FDA 3000 Instructions ( User Guide).pdf Instruction
3000 Color Certification Online Form FDA 3000.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Sample to accompany request (21 CFR 80.22)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 80.22

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3000	Color Certification Online	Form FDA 3000.doc		Yes	Yes	Fillable Printable
Instruction			Form FDA 3000 Instructions ( User Guide).pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 90 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-6,965	6,965
Annual IC Time Burden (Hours)	-348	348
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.