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U.S. Department of Health and Human Services

For Industry

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PDUFA Dear Colleague Letter for 2003 - Attachment A


 		Our files show the contact person, address, and telephone number below for all correspondence, invoices, and inquiries for your firm pertaining to user fees under the PDUFA. Please make corrections below. Please confirm that the information presented is correct and sign, date, and return this page to us.

 		 

 		 

 		Name of Firm: 

 		Address of Firm: 

 		 

 		 

 		Attention 

 		Title: 

 		Phone:

 		Facsimile

 		Changes are needed.

 		No changes.

 		TAX ID Number:

 		Signature:

 		Title:

 		Date:

 

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