Certificate of Identity - FDA Form 3975

Certification of Identity for Freedom of Information and Privacy Act Requests

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0832 can be found here:

Documents and Forms

Document Name Document Type
Form 3975 Certificate of Identity - FDA Form 3975 Form
3975 Certificate of Identity FORM FDA 3975 4-25-2017.docx Form

Information Collection (IC) Details

IC Title:	Certificate of Identity - FDA Form 3975	Agency IC Tracking Number:	ORA

Is this a Common Form? No		IC Status: New

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	3975	Certificate of Identity	FORM FDA 3975 4-25-2017.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 3

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	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.