Information Collection

Certification of Compliance with 42 U.S.C. § 282(j)(5)(B)

IC 258995 under ICR 202303-0910-005 · OMB 0910-0332.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0332 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA 3674 Certification of Compliance with 42 U.S.C. § 282(j)(5)(B)	Form
Form FDA 3674 Certification of Compliance with 42 U.S.C. § 282(j)(5)(B)	Form
FDA 3674 Certification of Compliance with 42 USC 282(j)(5)(B) Form FDA 3674 Cert of Compliance 42 CFR part 11.pdf	Form
FDA 3674 Certification of Compliance with 42 USC 282(j)(5)(B) Form FDA 3674 Cert of Compliance 42 CFR part 11.pdf	Form

IC Title:

Certification of Compliance with 42 U.S.C. § 282(j)(5)(B)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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	FDA 3674	Certification of Compliance with 42 USC 282(j)(5)(B)	Form FDA 3674 Cert of Compliance 42 CFR part 11.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	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.