Information Collection

CBER Export Certificate (FDA 3613, 3613b, 3613c)

IC 6208 under ICR 202003-0910-012 · OMB 0910-0498.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0498 can be found here:

Documents and Forms

Document Name Document Type
Form FDA 3613 CBER Export Certificate (FDA 3613, 3613b, 3613c) Form and Instruction
FDA 3613 Supplementary Information Certificate to Foreign Governm FDA-3613.pdf Form and Instruction
FDA 3613a Supplementary Information Certificate of Exportability R FDA-3613a.pdf Form and Instruction
FDA 3613b Supplementary Information Certificate of a Pharmaceutica FDA-3613b.pdf Form and Instruction
FDA 3613c Supplementary Information Non-Clinical Research Use Only FDA-3613c.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CBER Export Certificate (FDA 3613, 3613b, 3613c)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDA 3613	Supplementary Information Certificate to Foreign Government Requests	FDA-3613.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 3613a	Supplementary Information Certificate of Exportability Requests	FDA-3613a.pdf	Yes	No	Fillable Fileable
Form and Instruction	FDA 3613b	Supplementary Information Certificate of a Pharmaceutical Product	FDA-3613b.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	FDA 3613c	Supplementary Information Non-Clinical Research Use Only Certificate	FDA-3613c.pdf	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,651	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,651	2,651
Annual IC Time Burden (Hours)	2,651	2,651
Annual IC Cost Burden (Dollars)	463,925	463,925

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.