Device Facility User Fee Cover Sheet (Form FDA 3601(a))

Medical Device User Fee Cover Sheet and Device Facility User Fee Cover Sheet — Form FDA 3601 and Form 3601(a)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0511 can be found here:

Documents and Forms

Document Name Document Type
Form FDA 3601(a) Device Facility User Fee Cover Sheet (Form FDA 3601(a)) Form
FDA 3601(a) Device Facility User Fee 0511_Form 3601(a).pdf Form
FDA 3601(a) Device Facility User Fee 0511_Form 3601(a).pdf Form

Information Collection (IC) Details

IC Title:	Device Facility User Fee Cover Sheet (Form FDA 3601(a))	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FDA 3601(a)	Device Facility User Fee	0511_Form 3601(a).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: 24,086	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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	24,086	24,086
Annual IC Time Burden (Hours)	4,095	4,095
Annual IC Cost Burden (Dollars)	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.