User Fee Payment Refund Request --Form FDA 3913

Electronic User Fee Payment Form Requests

Documents and Forms

Document Name Document Type
Form Form FDA 3913 User Fee Payment Refund Request --Form FDA 3913 Form
Form FDA 3913 Refund Request 0805_FORM FDA 3913.pdf Form

Information Collection (IC) Details

IC Title:	User Fee Payment Refund Request --Form FDA 3913	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form FDA 3913	Refund Request	0805_FORM FDA 3913.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: 1,856	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 95 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,856	1,382	474
Annual IC Time Burden (Hours)	742	552	190
Annual IC Cost Burden (Dollars)	0	0	0

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.