Information Collection

Reporting: NAD for Investigational Use

IC 5728 under ICR 202312-0910-002 · OMB 0910-0117.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PP1243.4066.pdf	Instruction
PP1243.4066.pdf	Instruction
NCIR Template Form 2024.pdf	Other-Template Form
NCIR Template Form 2024.pdf	Other-Template Form
Landing Page Statement.jpg	Other-Landing page with PRA Statemen
Landing Page Statement.jpg	Other-Landing page with PRA Statemen

IC Title:

Agency IC Tracking Number:

CVM

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 511; 511.1 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Yes	Yes	Fillable Fileable
Other-Template Form	Yes	Yes	Fillable Fileable
Other-Landing page with PRA Statement	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 257

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	1,466	-247	1,713
Annual IC Time Burden (Hours)	1,634	-387	2,021
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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