Information Collection

User Fee Payment Transfer Request--Form FDA 3914

IC 218311 under ICR 202403-0910-004 · OMB 0910-0805.

Documents and Forms

Document Name Document Type
Form Form FDA 3914 User Fee Payment Transfer Request--Form FDA 3914 Form
Form FDA 3914 Transfer Request 0805_FORM FDA 3914.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	User Fee Payment Transfer Request--Form FDA 3914	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 3914	Transfer Request	0805_FORM FDA 3914.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: 86	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	86	-108	194
Annual IC Time Burden (Hours)	22	-27	49
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.