Information Collection

CBER Export Certificate (FDA 3613, 3613a, 3613b, 3613c, 3613g)

IC 6208 under ICR 202308-0910-003 · OMB 0910-0498.

Documents and Forms

Document Name Document Type
Form FDA 3613 CBER Export Certificate (FDA 3613, 3613a, 3613b, 3613c, 3613g) Form and Instruction
FDA 3613 Supplementary Information Certificate to Foreign Governm FDA-3613_Stat_Sec_Ext_04-25-24.pdf Form and Instruction
FDA 3613 Supplementary Information Certificate to Foreign Governm FDA-3613_Stat_Sec_Ext_04-25-24.pdf Form and Instruction
FDA 3613a Supplementary Information Certificate of Exportability R FDA-3613a_Stat_Sec_Ext_04-25-24.pdf Form and Instruction
FDA 3613a Supplementary Information Certificate of Exportability R FDA-3613a_Stat_Sec_Ext_04-25-24.pdf Form and Instruction
FDA 3613b Supplementary Information Certificate of a Pharmaceutica FDA-3613b_Stat_Sec_Ext_01-24-23 (2).pdf Form and Instruction
FDA 3613b Supplementary Information Certificate of a Pharmaceutica FDA-3613b_Stat_Sec_Ext_01-24-23 (2).pdf Form and Instruction
FDA 3613c Supplementary Information Non-Clinical Research Use Only FDA-3613c_Stat_Sec_Ext_04-25-24.pdf Form and Instruction
FDA 3613c Supplementary Information Non-Clinical Research Use Only FDA-3613c_Stat_Sec_Ext_04-25-24.pdf Form and Instruction
FDA 3613g Certificate To Foreign Government For Device Not Exporte FDA-3613g_Stat_Sec_Ext_04-25-2024.pdf Form and Instruction
FDA 3613g Certificate To Foreign Government For Device Not Exporte FDA-3613g_Stat_Sec_Ext_04-25-2024.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CBER Export Certificate (FDA 3613, 3613a, 3613b, 3613c, 3613g)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 21 CFR 1.101

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDA 3613	Supplementary Information Certificate to Foreign Government Requests	FDA-3613_Stat_Sec_Ext_04-25-24.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FDA 3613a	Supplementary Information Certificate of Exportability Requests	FDA-3613a_Stat_Sec_Ext_04-25-24.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FDA 3613b	Supplementary Information Certificate of a Pharmaceutical Product	FDA-3613b_Stat_Sec_Ext_01-24-23 (2).pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FDA 3613c	Supplementary Information Non-Clinical Research Use Only Certificate	FDA-3613c_Stat_Sec_Ext_04-25-24.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	FDA 3613g	Certificate To Foreign Government For Device Not Exported From the United States Requests	FDA-3613g_Stat_Sec_Ext_04-25-2024.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: 2,344	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,344	-307	2,651
Annual IC Time Burden (Hours)	2,344	-307	2,651
Annual IC Cost Burden (Dollars)	410,200	-53,725	463,925

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.