Information Collection

Requests for Designations: Combination Products reporting and records

IC 6241 under ICR 202311-0910-014 · OMB 0910-0523.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA 5003 Requests for Designations: Combination Products reporting and records	Form and Instruction
Form FDA 5003 REQUEST FOR DESIGNATION Requests for Designations: Combination Products reporting and records	Form and Instruction
Form FDA 5004 Pre-REQUEST FOR DESIGNATION-INFORMAL SUBMISSION Requests for Designations: Combination Products reporting and records	Form and Instruction
Form FDA 5005 Pre RFD - Supplemental Requests for Designations: Combination Products reporting and records	Form and Instruction
GFI How to Write an RFD - April 2011.pdf	Other-Agency Guidance
GFI How to Write an RFD - April 2011.pdf	Other-Agency Guidance
GFI How-to-Prepare-a-PreRFD - February 2018.pdf	Other-Agency Guidance
GFI How-to-Prepare-a-PreRFD - February 2018.pdf	Other-Agency Guidance
GFI Requesting Feedback Combo Products - December 2020pdf.pdf	Other-Agency Guidance
GFI Requesting Feedback Combo Products - December 2020pdf.pdf	Other-Agency Guidance
FDA 5003 REQUEST FOR DESIGNATION Form FDA 5003 RFD 2020.pdf	Form and Instruction
FDA 5003 REQUEST FOR DESIGNATION Form FDA 5003 RFD 2020.pdf	Form and Instruction
FDA 5004 Pre-REQUEST FOR DESIGNATION-INFORMAL SUBMISSION Form FDA 5004 Pre RFD 2020.pdf	Form and Instruction
FDA 5004 Pre-REQUEST FOR DESIGNATION-INFORMAL SUBMISSION Form FDA 5004 Pre RFD 2020.pdf	Form and Instruction
FDA 5005 Pre RFD - Supplemental Form FDA 5005 Pre RFD Supplement 2020.pdf	Form and Instruction
FDA 5005 Pre RFD - Supplemental Form FDA 5005 Pre RFD Supplement 2020.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Requests for Designations: Combination Products reporting and records

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 3 and 4

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDA 5003	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 5004	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 5005	Yes	Yes	Fillable Fileable
Other-Agency Guidance		Yes	Yes	Fillable Fileable
Other-Agency Guidance		Yes	Yes	Fillable Fileable
Other-Agency Guidance		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 135

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	Previously Approved
Annual Number of Responses for this IC	135	-4	139
Annual IC Time Burden (Hours)	3,243	-96	3,339
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.

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