| 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: |
FDA/Center for Drug Evaluation and Research
Last Updated: May 6, 2003
Originator: ORP
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