Information Collection

Certification of Identity; Form FDA 3975

IC 226535 under ICR 202210-0910-005 · OMB 0910-0832.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0832 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA 3975 Certification of Identity; Form FDA 3975	Form and Instruction
FDA 3975 Certification of Identify FDA-3975_06-23-20-Secured (2).pdf	Form and Instruction
FDA 3975 Certification of Identify FDA-3975_06-23-20-Secured (2).pdf	Form and Instruction

IC Title:

Certification of Identity; Form FDA 3975

Agency IC Tracking Number:

ORA

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 20 and 21

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 and Instruction	FDA 3975	Certification of Identify	FDA-3975_06-23-20-Secured (2).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: (SORN) 09-90-0058

FR Citation: 81 FR 17463

Number of Respondents: 24

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	24	-26	50
Annual IC Time Burden (Hours)	4	-5	9
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.