Information Collection

Expanded Individual Patient Access Application Submissions

IC 220651 under ICR 202106-0910-011 · OMB 0910-0814.

Information Collection (IC) Details

View Information Collection (IC)

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Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Agency Guidance 0814 Exp Access GFI Updated Oct 2017.pdf Yes Yes Fillable Fileable
Form Form FDA 3926 Individual Patient Expanded Access Investigational New Drug Application 0814_Form FDA 3926_2021.pdf Yes Yes Fillable Fileable
Instruction 0814_Form FDA 3926_Instructional Supplement_2021.pdf Yes Yes Fillable Fileable
Other-eSubmitter screenshots 0814 submission app screenshots SEP 2020.pdf Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,394 0 0 0 0 2,394
Annual IC Time Burden (Hours) 1,796 0 0 0 0 1,796
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
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.