Information Collection

Certification of Identity; Form FDA 3975

IC 226535 under ICR 202606-0910-001 · OMB 0910-0832.

Documents and Forms

Document Name Document Type
Form FDA 3975 Certification of Identify Certification of Identity; Form FDA 3975 Form and Instruction
FDA 3975 Certification of Identify 0832_Form FDA 3975_2026.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification of Identity; Form FDA 3975	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 20 and 21

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDA 3975	Certification of Identify	0832_Form FDA 3975_2026.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: (SORN) 09-90-0058	FR Citation: 81 FR 17463

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 70 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	24	0	24
Annual IC Time Burden (Hours)	12	8	4
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.

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