User Fee Payment Refund Request --Form FDA 3913

Electronic User Fee Payment Form Requests

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.