Individual Patient Expanded Access Applications

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0814_Form FDA 3926_Instructional Supplement - Edited 2021.pdf	Supplementary Document	Uploaded 2021-06-22	Repair queued
0814_Form FDA 3926 - Edited 2021.pdf	Supplementary Document	Uploaded 2021-06-22	Repair queued
0814_Change Request Form FDA 3926_JUN 2021.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-06-22	Repair queued
0814 Change Request User App SEP 2020.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-09-09	Repair queued
0814 Exp Access SSA 2019 Ext Final.pdf	Supporting Statement A	Uploaded 2019-04-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
220651	Expanded Individual Patient Access Application Submissions	Other-Agency Guidance	Modified

ICR Details

OMB Control No: 0910-0814	ICR Reference No: 202106-0910-011
Status: Received in OIRA	Previous ICR Reference No: 202009-0910-005
Agency/Subagency: HHS/FDA	Agency Tracking No: CDER
Title: Individual Patient Expanded Access Applications
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/22/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	05/31/2022	05/31/2022
Responses	2,394	2,394
Time Burden (Hours)	1,796	1,796
Cost Burden (Dollars)	0	0

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Abstract: This ICR collects information from licensed physicians who submit requests for expanded access to investigational drugs on behalf of individual patients. Physicians may use Form FDA 3926 instead of Form FDA 1571 for the submission of information as described in the regulations (e.g., the rationale for the intended use of the drug and the physician’s qualifications). We use the information to determine whether the access request can be granted. Form FDA 3926 may also be used for certain follow-up submissions to existing individual patient expanded access INDs as described in FDA regulations (e.g., to submit an annual report or summary of expanded access use (treatment completed)).

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Authorizing Statute(s): US Code: 21 USC 360bbb Name of Law: FD&C Act; Expanded Access to Unapproved Therapies and Diagnostics
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 55723	11/07/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 16022	04/17/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Expanded Individual Patient Access Application Submissions	Form FDA 3926	Individual Patient Expanded Access Investigational New Drug Application

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,394	2,394	0	0	0	0
Annual Time Burden (Hours)	1,796	1,796	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $134,159

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/22/2021

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