Information Collection

Reporting; Exemptions--803.19

IC 202630 under ICR 202412-0910-004 · OMB 0910-0437.

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IC Title:	Reporting; Exemptions--803.19	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 803 21 CFR 4

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	Number of Respondents for Small Entity: 5

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

Percentage of Respondents Reporting Electronically: 99 %

	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	28	-787	815
Annual IC Time Burden (Hours)	28	-54	82
Annual IC Cost Burden (Dollars)	0	0	0

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