Information Collection

(CBER) Submissions related to expanded access and treatment of an individual patient

IC 253121 under ICR 202309-0910-005 · OMB 0910-0814.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA 3926 (CBER) Submissions related to expanded access and treatment of an individual patient	Form
Form FDA 3926 Individual Patient Expanded Access Investigational (CBER) Submissions related to expanded access and treatment of an individual patient	Form
FDA-3926_instructions.pdf	Instruction
FDA-3926_instructions.pdf	Instruction
eSubmitter Screenshots.pdf	Other-eSubmitter Screenshots
eSubmitter Screenshots.pdf	Other-eSubmitter Screenshots
0814_Guidance.pdf	Other-Agency Guidance
0814_Guidance.pdf	Other-Agency Guidance
FDA 3926 Individual Patient Expanded Access Investigational Form FDA 3926.pdf	Form
FDA 3926 Individual Patient Expanded Access Investigational Form FDA 3926.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 21 CFR 312

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FDA 3926	Individual Patient Expanded Access Investigational	Form FDA 3926.pdf	Yes	Yes	Fillable Fileable
Instruction			FDA-3926_instructions.pdf	Yes	No	Printable Only
Other-eSubmitter Screenshots			eSubmitter Screenshots.pdf	Yes	No	Fillable Fileable Signable
Other-Agency Guidance			0814_Guidance.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 118

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
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-154	154
Annual IC Time Burden (Hours)	-1,232	1,232
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.