Information Collection

User Fee Payment Refund Request --Form FDA 3913

IC 218309 under ICR 202108-0910-001 · OMB 0910-0805.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0805 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form FDA 3913 User Fee Payment Refund Request --Form FDA 3913	Form
Form FDA 3913 Refund Request Refund_Request_Form FDA 3913.pdf	Form
Form FDA 3913 Refund Request Refund_Request_Form FDA 3913.pdf	Form

IC Title:

User Fee Payment Refund Request --Form FDA 3913

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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
Form	Form FDA 3913	Refund Request	Refund_Request_Form FDA 3913.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: 474

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	474	-1,183	1,657
Annual IC Time Burden (Hours)	190	-473	663
Annual IC Cost Burden (Dollars)	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.