Certificate of Identity; Form FDA 3975

Certification of Identity for Freedom of Information and Privacy Act Requests

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form FDA 3975 Certificate of Identity; Form FDA 3975 Form and Instruction
FDA 3975 Certification of Identify Form 3975 Cert. of ID.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Certificate of Identity; Form FDA 3975	Agency IC Tracking Number:	ORA

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 20 and 21

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDA 3975	Certification of Identify	Form 3975 Cert. of ID.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: (SORN) 09-90-0058	FR Citation: 81 FR 17463

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	-10	60
Annual IC Time Burden (Hours)	9	-1	10
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.