Mandatory Adverse Event Reporting via the SRP (other than RFR reports)

FDA Adverse Event Reports; Electronic Submissions

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0645 can be found here:

Documents and Forms

Document Name Document Type
0645 IC2 CVM adverse drug experiences and product defects RQ screenshots 2013.pdf Other-(Screen shots for CVM collecti
0645 IC2 Mandatory DSR Wireframes.pdf Other-eForm Submission

Information Collection (IC) Details

IC Title:	Mandatory Adverse Event Reporting via the SRP (other than RFR reports)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-(Screen shots for CVM collection)			0645 IC2 CVM adverse drug experiences and product defects RQ screenshots 2013.pdf		Yes	No	Paper Only
Other-eForm Submission			0645 IC2 Mandatory DSR Wireframes.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 636	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	636	636
Annual IC Time Burden (Hours)	636	636
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.