Electronic User Fee Payment Form Requests

OMB 0910-0805

OMB 0910-0805

This ICR collects information from customers who wish to electronically submit a user fee refund request for a duplicate payment, overpayment or for a withdrawn application or submission. Respondents submit organization, contact and payment information. Food and Drug Administration (FDA) has developed Form 3913 to facilitate its review and processing of user fee payment refunds. The information is used to determine the reason for the refund, the refund amount and who to contact if there are any questions regarding the refund request. A submission of the User Fee Payment Refund Request form does not guarantee that a refund will be issued. Additionally, this ICR collects information from customers who wish to electronically submit a request to transfer a user fee payment from one cover sheet or invoice to another cover sheet or invoice. Respondents submit payment and organization information. FDA has developed Form 3914 to facilitate its review and processing of user fee payment transfer requests. The information is used to determine the reason for the transfer, how the transfer should be performed and who to contact if there are any questions regarding the transfer request. A submission of the User Fee Payment Transfer Request form does not guarantee that a transfer will be performed.

The latest form for Electronic User Fee Payment Form Requests expires 2021-11-30 and can be found here.

OMB Details

User Fee Payment Refund Request --Form FDA 3913

Federal Enterprise Architecture: Health - Consumer Health and Safety

Form Form FDA 3913Refund RequestFillable Fileable SignableForm

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