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Federal Register / Vol. 70, No.

204 / Monday, October 24, 2005 / Notices 61447

submission of meeting requests and statements about the product and a about the product, a description of the
information packages under the description of the purpose and details of details for the anticipated meeting, and
guidance. the meeting. data and information that generally
would already have been compiled for
C. Request For a Formal Meeting D. Information Package
submission to the agency.
Based on data collected from the Based on data collected from the As stated earlier, the guidance
review divisions and offices within review divisions and offices within provides information on how the agency
CDER and CBER, FDA estimates that CDER and CBER, FDA estimates that will interpret and apply section 119(a)
approximately 713 sponsors and approximately 615 respondents of the Modernization Act, specific
applicants (respondents) request submitted approximately 1,365 PDUFA goals for the management of
approximately 1,783 formal meetings information packages to CDER annually meetings associated with the review of
with CDER annually and approximately and approximately 132 respondents human drug applications for PDUFA
164 respondents request approximately submitted approximately 208 products, and provisions of existing
286 formal meetings with CBER information packages to CBER annually regulations describing certain meetings
annually regarding the development and prior to a formal meeting regarding the (§§ 312.47 and 312.82). The information
review of a PDUFA product. The hours development and review of a PDUFA collection provisions in § 312.47
per response, which is the estimated product. The hours per response, which concerning End of Phase 2 meetings and
number of hours that a respondent is the estimated number of hours that a Pre NDA meetings have been approved
would spend preparing the information respondent would spend preparing the by OMB (OMB control number 0910–
to be submitted with a meeting request information package in accordance with 0014). However, the guidance provides
in accordance with the guidance, is the guidance, is estimated to be additional recommendations for
estimated to be approximately 10 hours. approximately 18 hours. Based on submitting information to FDA in
Based on FDA’s experience, the agency FDA’s experience, the agency expects it support of a meeting request. As a
expects it will take respondents this will take respondents this amount of result, FDA is submitting for OMB
amount of time to gather and copy brief time to gather and copy brief statements approval these additional estimates.

TABLE 1.—ESTIMATED ANNUAL REPORTING BURDEN


Meeting Re-
quests and In- Number of Responses Total Annual Re-
Number of Respondents Hours Per Response Total Hours
formation Per Respondent sponses
Packages

Meeting Requests

CDER 713 2.50 1,783 10 17,830

CBER 164 1.74 286 10 2,860

Total 20,690

Information Packages

CDER 615 2.22 1,365 18 24,570

CBER 132 1.58 208 18 3,744

Total 28,314

Grand Total 49,004

Dated: October 17, 2005. DEPARTMENT OF HEALTH AND ACTION: Notice.


Jeffrey Shuren, HUMAN SERVICES
SUMMARY: The Food and Drug
Assistant Commissioner for Policy.
Food and Drug Administration Administration (FDA) is announcing
[FR Doc. 05–21151 Filed 10–21–05; 8:45 am] that a proposed collection of
BILLING CODE 4160–01–S information has been submitted to the
[Docket No. 2005N–0220]
Office of Management and Budget
Agency Information Collection (OMB) for review and clearance under
Activities; Submission for Office of the Paperwork Reduction Act of 1995.
Management and Budget Review; DATES: Fax written comments on the
Comment Request; Current Good collection of information by November
Manufacturing Practices and Related 23, 2005.
Regulations for Blood and Blood ADDRESSES: OMB is still experiencing
Components; and Requirements for significant delays in the regular mail,
Donor Testing, Donor Notification, and including first class and express mail,
‘‘Lookback’’ and messenger deliveries are not being
accepted. To ensure that comments on
AGENCY: Food and Drug Administration, the information collection are received,
HHS. OMB recommends that written

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61448 Federal Register / Vol. 70, No. 204 / Monday, October 24, 2005 / Notices

comments be faxed to the Office of communicable disease agents and in CFR 610.42(a)) requires a warning
Information and Regulatory Affairs, donor notification is to prevent the statement, including the identity of the
OMB, Attn: Fumie Yokota, Desk Officer transmission of communicable disease. communicable disease agent, on
for FDA, FAX: 202–395–6974. The information collection medical devices containing human
FOR FURTHER INFORMATION CONTACT: requirements in the CGMP, donor blood or blood components found to be
Jonna Capezzuto, Office of Management testing, donor notification, and reactive by a screening test for evidence
Programs (HFA–250), Food and Drug ‘‘lookback’’ regulations provide FDA of infection due to a communicable
Administration, 5600 Fishers Lane, with the necessary information to disease agent(s) or syphilis. Section
Rockville, MD 20857, 301–827–4659. perform its duty to ensure the safety, 610.46(a) (21 CFR 610.46(a)) requires
purity, and potency of blood and blood blood establishments to notify
SUPPLEMENTARY INFORMATION: In
components. These requirements consignees, within 72 hours, of
compliance with 44 U.S.C. 3507, FDA
establish accountability and traceability repeatedly reactive test results so that
has submitted the following proposed
in the processing and handling of blood previously collected blood and blood
collection of information to OMB for
and blood components and enables FDA components are appropriately
review and clearance.
to conduct meaningful inspections. The quarantined. Section 610.46(b) requires
Current Good Manufacturing Practices recordkeeping requirements serve blood establishments to notify
and Related Regulations for Blood and preventative and remedial purposes. consignees of licensed, more specific
Blood Components; and Requirements The disclosure requirements identify test results for HIV within 30 calendar
for Donor Testing, Donor Notification, the various blood and blood days after the donors’ repeatedly
and ‘‘Lookback’’ (OMB Control Number components and important properties of reactive test. Section 610.47(b) (21 CFR
0910–0116)—Extension the product, demonstrate that the CGMP 610.47(b)) requires transfusion services
requirements have been met, and not subject to the Centers for Medicare
Under the statutory requirements
facilitate the tracing of a product back and Medicaid Services (CMS)
contained in section 351 of the Public
to its original source. The reporting regulations to notify physicians of prior
Health Service Act (PHS Act) (42 U.S.C.
requirements inform FDA of any donation recipients or to notify
262), no blood, blood component, or
deviations that occur and that may recipients themselves of the need for
derivative may move in interstate
require immediate corrective action. HIV testing and counseling. Section
commerce unless: (1) It is propagated or Under the reporting requirements,
manufactured and prepared at an 630.6(a) (21 CFR 630.6(a)) requires an
§ 606.170(b) (21 CFR 606.170(b)) establishment to make reasonable
establishment holding an unsuspended requires that fatal complications of
and unrevoked license; (2) the product attempts to notify any donor who has
blood collection and transfusions be been deferred as required by § 610.41
complies with regulatory standards reported to FDA as soon as possible and
designed to ensure safety, purity, and (21 CFR 610.41), or who has been
that a written report shall be submitted
potency; and (3) it bears a label plainly determined not to be eligible as a donor.
within 7 days. Section 610.40(c)(1)(ii)
marked with the product’s proper name, Section 630.6(d)(1) requires an
(21 CFR 610.40(c)(1)(ii)) requires each
manufacturer, and expiration date. In establishment to provide certain
dedicated donation be labeled as
addition, under the biologics licensing information to the referring physician of
required under 21 CFR 606.121 and
and quarantine provisions in sections an autologous donor who is deferred
with a label entitled ‘‘INTENDED
351–361 of the PHS Act (42 U.S.C. 262– based on the results of tests as described
RECIPIENT INFORMATION LABEL’’
264) and the general administrative in § 610.41.
containing the name and identifying
provisions under sections 501–503, information of the recipient. Section Under the recordkeeping
505–510, and 701–704 of the Federal 610.40(g)(2) requires an establishment to requirements, § 606.100(b) (21 CFR
Food, Drug, and Cosmetic Act (21 U.S.C. obtain written approval from FDA to 606.100(b)) requires that written
351–353, 355–360, and 371–374), FDA ship human blood or blood components standard operating procedures (SOPs)
has the authority to issue and enforce for further manufacturing use prior to be maintained for the collection,
regulations designed to protect the completion of testing. Section processing, compatibility testing,
public from unsafe or ineffective 610.40(h)(2)(ii)(A) requires an storage, and distribution of blood and
biological products and to issue establishment to obtain written approval blood components used for transfusion
regulations necessary to prevent the from FDA to use or ship human blood and manufacturing purposes. Section
introduction, transmission, or spread of or blood components found to be 606.100(c) requires the review of all
communicable diseases between States reactive by a screening test for evidence pertinent records to a lot or unit of
or possession or from foreign countries of a communicable disease agent(s) or blood prior to release. Any unexplained
into the States or possession. The collect from a donor with a record of a discrepancy or failure of a lot or unit of
current good manufacturing practice reactive screening test. Sections final product to meet any of its
(CGMP) and related regulations 610.40(h)(2)(ii)(C) and (h)(2)(ii)(D) specifications must be thoroughly
implement FDA’s statutory authority to require an establishment to label investigated, and the investigation,
ensure the safety, purity, and potency of reactive human blood and blood including conclusions and followup,
blood and blood components. The components with the appropriate must be recorded. Section 606.110(a)
‘‘lookback’’ requirements are intended screening test results, and, if they are (21 CFR 606.110(a)) requires a physician
to help ensure the continued safety of intended for further manufacturing use to certify in writing that the donor’s
the blood supply by providing necessary into injectable products, with a health permits plateletpheresis or
information to users of blood and blood statement indicating the exempted use leukapheresis if a variance from
components and appropriate specifically approved by FDA. Section additional regulatory standards for a
notification of recipients of transfusion 610.40(h)(2)(vi) requires each donation specific product is used when obtaining
who are at increased risk for of human blood or blood component the product from a specific donor for a
transmitting human immunodeficiency that tests reactive by a screening test for specific recipient. Section 606.110(b)
virus (HIV) infection. The public health syphilis and is determined to be a requires establishments to request prior
objective in testing human blood donors biological false positive be labeled with Center for Biologics Evaluation and
for evidence of infection due to both test results. Section 610.42(a) (21 Research (CBER) approval for

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Federal Register / Vol. 70, No. 204 / Monday, October 24, 2005 / Notices 61449

plasmapheresis of donors who do not and blood components, including two labels; one as reactive for the
meet donor requirements. The Source Plasma and Source Leukocytes appropriate screening test under
information collection requirements for inspected by FDA, and other transfusion § 610.40(h)(2)(ii)(C), and the other
§ 606.110(b) are reported and approved services inspected by CMS. Based on stating the exempted use specifically
under OMB control number 0910–0338 information received from CBER’s approved by FDA under
which expires August 31, 2005. Section database systems, there are § 610.40(h)(2)(ii)(D). According to
606.151(e) (21 CFR 606.151(e)) requires approximately 81 licensed Source CBER’s database system, there are an
that records of expedited transfusions in Plasma collection establishments with estimated 40 licensed manufacturers
life-threatening emergencies be multiple locations and 1,628 registered that ship known reactive human blood
maintained. So that all steps in the Whole Blood collection establishments or blood components.
collection, processing, compatibility for a total of 1,709 establishments. There Based on information we received
testing, storage and distribution, quality are approximately 2,156 registered from industry, we estimate that
control, and transfusion reaction reports blood establishments inspected by FDA. approximately 18,000 donations
and complaints for each unit of blood Of these establishments, approximately annually test reactive by a screening test
and blood components can be clearly 773 perform plateletpheresis and for syphilis, and are determined to be
traced, § 606.160 (21 CFR 606.160) leukopheresis. These establishments biological false positives by additional
requires that legible and indelible annually collect approximately 28 testing and labeled accordingly
contemporaneous records of each million units of Whole Blood, blood (§ 610.40(h)(2)(vi)).
significant step be made and maintained components including Source Plasma, Human blood or a blood component
for no less than 5 years. Section and Source Leukocytes and are required with a reactive screening test, as a
606.160(b)(1)(ix) requires a facility to to follow FDA ‘‘lookback’’ procedures, component of a medical device, is an
maintain records of notification of and approximately 134 are registered integral part of the medical device, e.g.,
donors deferred or determined not to be transfusion services that are not subject a positive control for an in vitro
eligible for donation, including to CMS’s ‘‘lookback’’ regulations. Based diagnostic testing kit. It is usual and
appropriate followup if the initial on CMS records, there are an estimated customary business practice for
notification attempt fails. Section 4,980 transfusion services approved for manufacturers to include on the
606.160(b)(1)(xi) requires an Medicare reimbursement. container label a warning statement that
establishment to maintain records of The following reporting and identifies the communicable disease
notification of the referring physician of recordkeeping estimates are based on agent. In addition, on the rare occasion
a deferred autologous donor, including information provided by industry, CMS, when a human blood or blood
appropriate followup if the initial and FDA experience. Based on component with a reactive screening
notification attempt fails. Section information received from industry, we test is the only component available for
606.165 (21 CFR 606.165) requires that estimate that there are an average of 13 a medical device that does not require
distribution and receipt records be million donations of Source Plasma a reactive component, then a statement
maintained to facilitate recalls, if from approximately 2 million donors of warning is required to be affixed to
necessary. Section 606.170(a) requires and 15 million donations of Whole the medical device. To account for this
records to be maintained of any reports Blood, including 300,000 (2 percent of rare occasion under § 610.42(a), we
of complaints of adverse reactions as a 15 million) autologous, from estimate that the warning statement
result of blood collection or transfusion. approximately 8 million donors. would be necessary no more than once
Each such report must be thoroughly Assuming each autologous donor makes a year.
investigated, and a written report, an average of 2 donations, FDA Based on information received from
including conclusions and followup, estimates that there are approximately industry, we estimate that there are
must be prepared and maintained. 150,000 autologous donors. approximately 4,424 repeat donors that
Section 610.40(g)(1) requires an FDA estimates that approximately 5 will test reactive on a screening test for
establishment to appropriately percent (12,000) of the 240,000 HIV with 159 confirmed positive. We
document a medical emergency for the donations that are donated specifically estimate that each repeat donor has
release of human blood or blood for the use of an identified recipient donated two previous times and an
components prior to completion of would be tested under the dedicated average of three components were made
required testing. donors testing provisions in from each donation. Under § 610.46(a)
In addition to the CGMPs in part 606 § 610.40(c)(1)(ii). and (b), this estimate results in 26,544
(21 CFR part 606), there are regulations Under § 610.40(g)(2) and (h)(2)(ii)(A), (4,424 x 2 x 3) notifications of the HIV
in part 640 (21 CFR part 640) that the only product currently shipped screening test results to consignees by
require additional standards for certain prior to completion of testing is a collecting establishments for the
blood and blood components as follows: licensed product, Source Leukocytes, purpose of quarantining affected blood
Sections 640.3(a)(1), (a)(2), and (f); used in the manufacture of interferon, and blood components, and another
640.4(a)(1) and (a)(2); 640.25(b)(4) and which requires rapid preparation from 26,544 (4,424 x 2 x 3) notifications to
(c)(1); 640.27(b); 640.31(b); 640.33(b); blood. Shipments of Source Leukocytes consignees of subsequent test results.
640.51(b); 640.53(b) and (c); 640.56(b) are preapproved under a biologics Under § 610.47(b), based also on the
and (d); 640.61; 640.63(b)(3), (e)(1), and license application and each shipment information received from industry, we
(e)(3); 640.65(b)(2); 640.66; 640.71(b)(1); does not have to be reported to the estimate that 80 percent of the 159 (127)
640.72; 640.73; and 640.76(a) and (b). agency. Based on information from confirmed HIV positive were from
The information collection requirements CBER’s database system, FDA receives repeat donors of Whole Blood
and estimated burdens for these an estimated 1 application per year from donations.
regulations are included in the part 606 manufacturers of Source Leukocytes. Industry estimates that approximately
burden estimates, as described in Tables Under § 610.40(h)(2)(ii)(C) and 13 percent of 10 million potential
1 and 2 of this document. (h)(2)(ii)(D), FDA estimates that each donors (1.3 million donors) who come
Respondents to this collection of manufacturer would ship an estimated 1 to donate annually are determined not
information are licensed and unlicensed human blood or blood component per to be eligible for donation prior to
blood establishments that collect blood month (12 per year) that would require collection because of failure to satisfy

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61450 Federal Register / Vol. 70, No. 204 / Monday, October 24, 2005 / Notices

eligibility criteria. It is the usual and As part of usual and customary establishments collect autologous
customary business practice of 1,709 business practice, collecting donations and, therefore, are required to
collecting establishments to notify establishments notify an autologous notify referring physicians. We estimate
onsite and to explain the reason why the donor’s referring physician of reactive that 4.5 percent of the 150,000
donor is determined not to be suitable test results obtained during the donation autologous donors (6,750) will be
for donating. Based on such available process required under § 630.6(d)(1). deferred under § 610.41 and thus result
information, we estimate that two-thirds However, we estimate that 5 percent of in the notification of their referring
of the 1,709 collecting establishments the 1,628 blood collection physicians.
provided onsite additional information establishments (81) may not notify the FDA has concluded that the use of
and counseling to a donor determined referring physicians of the estimated 2 untested or incompletely tested but
not to be eligible for donation as usual percent of 150,000 autologous donors appropriately documented human blood
and customary business practice. with reactive test results (3,000) as their or blood components in rare medical
Consequently, we estimate that only usual and customary business practice. emergencies should not be prohibited.
one-third or 570 collection The recordkeeping chart reflects the We estimate the recordkeeping under
establishments would need to provide, estimate that 95 percent of the § 610.40(g)(1) to be minimal with one or
under § 630.6(a), additional information recordkeepers, which collect 98 percent less occurrence per year. The reporting
and counseling onsite to the estimated of the blood supply, had developed of test results to the consignee in
433,333 (one-third of 1.3 million) SOPs as part of their customary and § 610.40(g) does not create a new burden
ineligible donors. usual business practice. Establishments for respondents because it is the usual
may minimize burdens associated with and customary business practice or
It is estimated that another 4.5 percent CGMP and related regulations by using procedure to finish the testing and
of 10 million donors (450,000 donors) model SOPs developed by industries’ provide the results to the manufacturer
are deferred annually based on test accreditation organizations. These responsible for labeling the blood
results. We estimate that currently 95 accreditation organizations represent products.
percent of the establishments that almost all registered blood The hours per response and hours per
collect 98 percent of the blood and establishments. record are based on estimates received
blood components notify donors who Under § 606.160(b)(1)(ix), we estimate from industry or FDA experience with
have reactive test results for HIV, the total annual records based on the 1.3 similar recordkeeping or reporting
Hepatitis B Virus (HBV), Hepatitis C million donors determined not to be requirements.
Virus (HCV), Human T-Lymphotropic eligible to donate and each of the In the Federal Register of June 21,
Virus (HTLV), and syphilis as usual and 450,000 (1,300,000 + 450,000 = 2005 (70 FR 35680), FDA published a
customary business practice. 1,750,000) donors deferred based on 60-day notice requesting public
Consequently, 5 percent (85) of the reactive test results for evidence of comment on the information collection
industry (1,709) collecting 2 percent infection due to communicable disease provisions. No comments were received.
(9,000) of the deferred donors (450,000) agents. Under § 606.160(b)(1)(xi), only FDA estimates the burden of this
would notify donor under § 630.6(a). the 1,628 registered blood collection of information as follows:

TABLE 1.—ESTIMATED ANNUAL REPORTING BURDEN1


No. of Annual Frequency Total Annual Hours per
21 CFR Section Total Hours
Respondents per Response Responses Response

606.170(b)2 82 1 82 20 1,640

610.40(c)(1)(ii) 1,628 8 12,000 0.08 960

610.40(g)(2) 1 1 1 1 1

610.40(h)(2)(ii)(A) 1 1 1 1 1

610.40(h)(2)(ii)(C) and
(h)(2)(ii)(D) 40 12 480 0.2 96

610.40(h)(2)(vi) 1,628 11 18,000 0.08 1,440

610.42(a) 1 1 1 1 1

610.46(a) 1,709 16 26,544 0.17 4,512

610.46(b) 1,709 16 26,544 0.17 4,512

610.47(b) 134 1 134 1 134

630.6(a)3 570 760 433,333 0.08 34,667

630.6(a)4 85 106 9,000 1.5 13,500

630.6(d)(1) 81 37 3,000 1 3,000

Total 64,464
1There are no capital costs or operating and maintenance costs associated with this collection of information.
2The reporting requirement in § 640.73, which addresses the reporting of fatal donor reactions, is included in the estimate for § 606.170(b).

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Federal Register / Vol. 70, No. 204 / Monday, October 24, 2005 / Notices 61451
3Notification of donors determined not to be eligible for donation based on failure to satisfy eligibility criteria.
4Notification of donors deferred based on reactive test results for evidence of infection due to communicable disease agents.

TABLE 2.—ESTIMATED ANNUAL RECORDKEEPING BURDEN1


No. of Annual Frequency Total Annual Hours per
21 CFR Section Total Hours
Recordkeepers per Recordkeeping Records Record

606.100(b)2 2495 1 249 24 5,976

606.100(c) 2495 10 2,490 1 2,490

606.110(a)3 396 1 39 0.5 20

606.151(e) 2495 12 2,988 0.083 248

606.1604 2495 1,928 480,000 0.75 360,000

606.160(b)(1)(ix) 1,709 1,024 1,750,000 0.05 87,500

606.160(b)(1)(xi) 1,628 4 6,750 0.05 338

606.165 2495 1,928 480,000 0.083 39,840

606.170(a) 2495 12 2,988 1 2,988

610.40(g)(1) 1,628 1 1,628 0.5 814

Total 500,214
1There are no capital costs or operating and maintenance costs associated with this collection of information.
2The recordkeeping requirements in §§ 640.3(a)(1), 640.4(a)(1), and 640.66, which address the maintenance of SOPs, are included in the esti-
mate for § 606.100(b).
3The recordkeeping requirements in § 640.27(b), which address the maintenance of donor health records for the plateletpheresis, are included
in the estimate for § 606.110(a).
4The recordkeeping requirements in §§ 640.3(a)(2) and (f); 640.4(a)(2); 640.25(b)(4) and (c)(1); 640.31(b); 640.33(b); 640.51(b); 640.53(b) and
(c); 640.56(b) and (d); 640.61; 640.63(b)(3), (e)(1), and (e)(3); 640.65(b)(2); 640.71(b)(1); 640.72; and 640.76(a) and (b), which address the
maintenance of various records are included in the estimate for § 606.160.
5Five percent of CMS transfusion services and FDA-registered blood establishments (0.05 X 4,980).
6Five percent of plateletpheresis and leukopheresis establishments (0.05 X 773).

Dated: October 17, 2005. the Paperwork Reduction Act of 1995 Waivers of In Vivo Demonstration of
Jeffrey Shuren, (the PRA). Bioequivalence of Animal Drugs in
Assistant Commissioner for Policy. Soluble Powder Oral Dosage Form
DATES: Fax written comments on the Products and Type A Medicated
[FR Doc. 05–21153 Filed 10–21–05; 8:45 am]
collection of information by November Articles
BILLING CODE 4160–01–S
23, 2005.
The generic Animal Drug and Patent
ADDRESSES: OMB is still experiencing Term Registration Act of 1988 permitted
DEPARTMENT OF HEALTH AND significant delays in the regular mail, generic drug manufacturers to copy
HUMAN SERVICES including first class and express mail, those pioneer drug products that were
and messenger deliveries are not being no longer subject to patent or other
Food and Drug Administration accepted. To ensure that comments on marketing exclusivity protection. The
the information collection are received, approval for marketing these generic
[Docket No. 2004D–0283]
OMB recommends that written products is based in part upon a
Agency Information Collection comments be faxed to the Office of demonstration of bioequivalence
Activities; Submission for Office of Information and Regulatory Affairs, between the generic product and
Management and Budget Review; OMB, Attn: Fumie Yokota, Desk Officer pioneer product. This guidance clarifies
Comment Request; Waivers of In Vivo for FDA, FAX: 202–395–6974. circumstances under which FDA
Demonstration of Bioequivalence of believes the demonstration of
FOR FURTHER INFORMATION CONTACT: bioequivalence by the stature does not
Animal Drugs in Soluble Powder Oral Denver Presley, Office of Management
Dosage Form Products and Type A need to be established on the basis of in
Programs (HFA–250), Food and Drug vivo studies for soluble powder oral
Medicated Articles
Administration, 5600 Fishers Lane, dosage form products and Type A
AGENCY: Food and Drug Administration, Rockville, MD 20857, 301–827–1472. medicated articles. The data submitted
HHS. SUPPLEMENTARY INFORMATION: In in support of the waiver request are
ACTION: Notice. necessary to validate the waiver
compliance with 44 U.S.C. 3507, FDA
decision.
SUMMARY: The Food and Drug
has submitted the following proposed The requirement to establish
Administration (FDA) is announcing collection of information to OMB for bioequivalence through in vivo studies
that a proposed collection of review and clearance. (blood level bioequivalence or clinical
information has been submitted to the endpoint bioequivalence) may be
Office of Management and Budget waived for soluble powder or Type A
(OMB) for review and clearance under medicated articles in either of two

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