*DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF ADDRESS BELOW.*
OMB NO. 0910-0716
Expiration Date: 08/31/2026
The burden for this collection of information is estimated to average 0.25 hour per response,
including the time to review instructions, search existing data sources, gather and maintain the data needed
and complete and review the collection of information. Send comments regarding this burden estimate
or any other aspect of this information collection, including suggestions for reducing this burden,
to the following address:
Department of Health and Human Services
Food and Drug Administration
Office of Chief Information Officer
Paperwork Reduction Act (PRA) Staff
PRAStaff@fda.hhs.gov
"An agency may not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a currently valid OMB number."
Form Approved: OMB NO. 0910-0716
Expiration Date: 08/31/2026
Please call us at 1-877-287-1373
or email us at ctpcompliance@fda.hhs.gov