UNOFFICIAL PREPARATION COPY
FDA USER FEE PAYMENT ID (PIN)
1. APPLICANT NAME AND ADDRESS
2. AUTHORIZED REPRESENTATIVE
5. CLINICAL DATA DETERMINATION
6. PRIORITY REVIEW VOUCHER
7. FEE EXCEPTION / EXEMPTION / WAIVER / REDUCTION
10. PAYMENT / INTERNAL REFERENCES
11. AUTHORIZED PREPARATION CERTIFICATION
This locally generated preparation copy is not an FDA submission, invoice, or evidence of payment. Submit the cover sheet in FDA's official user-fee system to obtain the official PD payment ID. Form FDA 3397 (03/19) - OMB No. 0910-0297.