FORM FDA 3674 - FDA-3674DynSecExt04-15-2024-2-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Sponsor/Applicant/Submitter' in the designated field. Ensure this matches the name on your application.
3. Input the 'Date of the Application/Submission' accurately to reflect when you are submitting this form.
4. Fill in your complete address, including telephone and fax numbers, ensuring all details are correct for effective communication.
5. For product information, specify all names associated with your drug, biologic, or device. Use a continuation page if necessary.
6. Select the type of application/submission from the provided options by checking the appropriate box.
7. If applicable, enter any previously assigned IND/NDA/ANDA/BLA/PMA number related to your submission.
8. In the certification section, check one of the boxes (A, B, or C) based on your compliance status regarding clinical trials.
9. If you checked Box C, provide any National Clinical Trial (NCT) Numbers relevant to your submission.
10. Complete the signature section by providing your name, title, and signing where indicated. Ensure all contact information is accurate.

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