Information Collection

New Written Request to be Placed on the List

IC 37675 under ICR 201708-0910-015 · OMB 0910-0509.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0509 can be found here:

Documents and Forms

Document Name Document Type
0509 DLM Mockups.docx Other-DLM Screens
0509 DLM Guidance Chile.docx Other-Guidance
DLM Guidance Opening Page.pdf Other-Opening Page

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	New Written Request to be Placed on the List	Agency IC Tracking Number:	CFSAN

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-DLM Screens	0509 DLM Mockups.docx	Yes	Yes	Fillable Fileable
Other-Guidance	0509 DLM Guidance Chile.docx	Yes	No	Paper Only
Other-Opening Page	DLM Guidance Opening Page.pdf	Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 200

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

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	2,000	125	1,875
Annual IC Time Burden (Hours)	2,000	188	1,812
Annual IC Cost Burden (Dollars)	0	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.