CVM Export Certificate (FDA 3613, 3613b)

Export Certificates for FDA Regulated Products

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0498 can be found here:

Documents and Forms

Document Name Document Type
Form FDA 3613 CVM Export Certificate (FDA 3613, 3613b) Form and Instruction
FDA 3613 SUPPLEMENTARY INFORMATION CERTIFICATE TO FOREIGN GOVERNM Mock up to 3613_02_06_20 (1).pdf Form and Instruction
FDA 3613 SUPPLEMENTARY INFORMATION CERTIFICATE TO FOREIGN GOVERNM Mock up to 3613_02_06_20 (1).pdf Form and Instruction
FDA 3613a SUPPLEMENTARY INFORMATION CERTIFICATE OF EXPORTABILITY R Mock up to 3613a_02_06_20 _2.pdf Form and Instruction
FDA 3613a SUPPLEMENTARY INFORMATION CERTIFICATE OF EXPORTABILITY R Mock up to 3613a_02_06_20 _2.pdf Form and Instruction
FDA 3613b SUPPLEMENTARY INFORMATION CERTIFICATE OF A PHARMACEUTICA Mock up to 3613b_02_06_20.pdf Form and Instruction
FDA 3613b SUPPLEMENTARY INFORMATION CERTIFICATE OF A PHARMACEUTICA Mock up to 3613b_02_06_20.pdf Form and Instruction
FDA 3613 Request for Certificate Supplementary Information FDA 3613 Export Certs Supplementary Information.pdf Form and Instruction
FDA 3613 Request for Certificate Supplementary Information FDA 3613 Export Certs Supplementary Information.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	CVM Export Certificate (FDA 3613, 3613b)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 21 CFR 1.101

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDA 3613	SUPPLEMENTARY INFORMATION CERTIFICATE TO FOREIGN GOVERNMENT REQUESTS	Mock up to 3613_02_06_20 (1).pdf	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 3613a	SUPPLEMENTARY INFORMATION CERTIFICATE OF EXPORTABILITY REQUESTS	Mock up to 3613a_02_06_20 _2.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 3613b	SUPPLEMENTARY INFORMATION CERTIFICATE OF A PHARMACEUTICAL PRODUCT	Mock up to 3613b_02_06_20.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 3613	Request for Certificate Supplementary Information	FDA 3613 Export Certs Supplementary Information.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: 1,925	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,925	1,925
Annual IC Time Burden (Hours)	1,925	1,925
Annual IC Cost Burden (Dollars)	336,875	336,875

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.