Free Request For A Meeting Or Teleconference - Federal

Guidance
DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Center for Veterinary Medicine

Export Data

Import Data

Reset Form

Request For A Meeting Or Teleconference

Form Approved: OMB No. 0910-0452 Expiration Date: 05/31/2010

PAPERWORK REDUCTION ACT STATEMENT: A Federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless it displays a current valid OMB control number. The public reporting burden for the collection of information is estimated to vary from 15 minutes to 2 hours, with an average of 60 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the necessary information, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information to the Food and Drug Administration, Center for Veterinary Medicine, 7500 Standish Place, Rockville, MD 20855.

A1. DATE:
Food and Drug Administration Center for Veterinary Medicine, HFV7500 Standish Place Rockville, Maryland 20855

A2. MULTIPLE DOCUMENTS: A3. DOCUMENT ID: , submits a request for a meeting or

The applicant, teleconference. This information is submitted in electronic form.

I.
1. 2. 3.

Meeting/Teleconference:
NAME(S) OF DRUG(S): SPECIES OF ANIMALS: PROPOSED DATE(S) AND TIME(S): Alternative Dates: 4. 5. PURPOSE OF MEETING: APPLICANT PARTICIPANTS: PRODUCTION CLASS:

9:00 am

6.

REQUESTED CVM PARTICIPANTS:

7.

TYPE OF MEETING:
In Person Conference
Other (Specify):

Teleconference

Video Teleconference

8.

AUDIO-VISUAL REQUIREMENTS:
Slides Other (Specify):


Overhead

Computer Projection

9.

MEETING REQUEST PREVIOUSLY SUBMITTED TO CVM: If Yes, 9a. Date Submitted to CVM:

YES

NO 9b. CVM Submission Identifier:

II.

Comments:
If you have additional comments that you would like to include in this submission please press the Insert Comments button below. All comments must be included within a PDF document.
Insert Comments

FORM FDA 3489 (10/2008) Version 5.2

Page 1

III.

Meeting Agenda:
Please press the Insert Agenda button to include your proposed meeting agenda. All meeting agendas must be included within a PDF document.
Insert Agenda

IV.
1. 2a. 2b. 2c. 2e. 3. 4. 5. 6.

Applicant Information:
Name: Address: Address 2: City: Country:

USA

2d. State/Prov: 2f. Postal Code:

Contact Name: Contact Phone Number: Contact Fax Number: Contact E-Mail Address:

1 - Validate

2 - Save

3 - Signature

FORM FDA 3489 (10/2008) Version 5.2

Page 2