Certification of Identity; Form FDA 3975

Certification of Identity for Freedom of Information and Privacy Act Requests

OMB: 0910-0832

IC ID: 226535

Information Collection (IC) Details

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Certification of Identity; Form FDA 3975 ORA
 
No Modified
 
Voluntary
 
21 CFR 20 and 21

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

Health Consumer Health and Safety

(SORN) 09-90-0058   81 FR 17463

24 0
   
Individuals or Households
 
   70 %

  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 24 0 0 -26 0 50
Annual IC Time Burden (Hours) 4 0 0 -5 0 9
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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