Types of Communication During 
the Review of Medical Device 
Submissions  
 
Guidance for Industry and Food 
and Drug Administration Staff
 
 
Document issued on: April 4, 2014 
 
This document supersedes Interactive Review for Medical Device 
Submissions: 510(k)s, Original PMAs, PMA Supplements, Original BLAs, 
and BLA Supplements dated February 28, 2008. 
 
The draft of this document was issued on April 5, 2013. 
 
 
For questions regarding this document, contact the Premarket Notification (510(k)) Section or 
the Premarket Approval (PMA) Section of CDRH at 301-796-5640 or CBERs Office of 
Communication, Outreach and Development at 1-800-835-4709 or 301-827-1800. 
  
 
 
 
 
 
 
 
U.S. Department of Health and Human Services 
Food and Drug Administration 
Center for Devices and Radiological Health 
Center for Biologics Evaluation and Research 
    Contains Nonbinding Recommendations 
 
Preface 
 
Public Comment 
 
You may submit written comments and suggestions at any time for Agency consideration to the 
Division of Dockets Management, Food and Drug Administration, 5630 Fishers Lane, 
rm. 1061, (HFA-305), Rockville, MD, 20852.  Submit electronic comments to 
http://www.regulations.gov.  Identify all comments with the docket number listed in the notice of 
availability that publishes in the Federal Register.  Comments may not be acted upon by the 
Agency until the document is next revised or updated. 
 
Additional Copies 
 
Additional copies are available from the Internet. You may also send an e-mail request to 
CDRH-Guidance@fda.hhs.gov  to receive an electronic copy. Please use the document number 
1804 to identify the guidance you are requesting.  
 
Additional copies of this guidance document are also available from the Center for Biologics 
Evaluation and Research (CBER), Office of Communication, Outreach and Development (HFM-
40), 1401 Rockville Pike, Suite 200N, Rockville, MD 20852-1448, by e-mail at 
ocod@fda.hhs.gov, or by calling 1-800-835-4709 or 301-827-1800, or from the Internet at 
http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/defau
lt.htm. 
 
 
  Contains Nonbinding Recommendations 
 
Table of Contents 
1.  Introduction .................................................................................................................... 1 
2.  Scope .............................................................................................................................. 2 
3.  Acceptance Review Communication ............................................................................. 3 
a.  Purpose of Acceptance Review Communication ................................................................ 3 
b.  Timing of Acceptance Review Communication ................................................................. 3 
c.  Content of Acceptance Review Communication ................................................................ 4 
4.  Substantive Interaction ................................................................................................... 4 
a.  Purpose of Substantive Interaction ..................................................................................... 4 
b.  Timing of Substantive Interaction ...................................................................................... 4 
c.  Content of Substantive Interaction ..................................................................................... 5 
5.  Interactive Review ......................................................................................................... 5 
a.  Purpose of Interactive Review ............................................................................................ 5 
b.  Timing and Expectations for Interactive Review ............................................................... 6 
c.  Types of Deficiencies Appropriate for Interactive Review ................................................ 6 
d.  The Interactive Review Process .......................................................................................... 7 
e.  Communication Tools for Interactive Review .................................................................... 8 
f.  Responses to Deficiencies Requested via the Interactive Review Process ........................ 9 
g.  Applicants Role in the Interactive Review Process ........................................................... 9 
h.  FDA Review Team Considerations .................................................................................. 11 
6.  Missed MDUFA Decision Communication ................................................................ 11 
a.  Purpose of Missed MDUFA Decision Communication ................................................... 11 
b.  Timing of Missed MDUFA Decision Communication .................................................... 11 
c.  Content of Missed MDUFA Decision Communication .................................................... 11 
  Contains Nonbinding Recommendations 
 
Types of Communication During the Review 
of Medical Device Submissions  
 
Guidance for Industry and Food and Drug 
Administration Staff
 
 
This guidance represents the Food and Drug Administration's (FDA's) current thinking on 
this topic.  It does not create or confer any rights for or on any person and does not operate to 
bind FDA or the public.  You can use an alternative approach if the approach satisfies the 
requirements of the applicable statutes and regulations.  If you want to discuss an alternative 
approach, contact the FDA staff responsible for implementing this guidance.  If you cannot 
identify the appropriate FDA staff, call the appropriate number listed on the title page of this 
guidance.  
   
1. Introduction  
During the review of a premarket submission, FDAs practice has been to communicate with 
applicants1 through either a formal communication (such as a Major Deficiency Letter or an 
additional information request issued through a letter, or through phone, fax, or email, with a 
follow-up letter confirming the hold) or through the process of Interactive Review.  The concept 
of Interactive Review was discussed in detail in the Commitment Letter from the Secretary of 
Health and Human Services (the Secretary) to Congress2 as part of the Medical Device User Fee 
Act (MDUFA) II of 2007 and the process was further described in the guidance Interactive 
Review for Medical Device Submissions: 510(k)s, Original PMAs, PMA Supplements, Original 
BLAs, and BLA Supplements 
(http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm0
89402.htm). 
 
The Medical Device User Fee Amendments of 20123 (MDUFA III), amended the Federal Food, 
Drug, and Cosmetic Act (FD&C Act) to authorize FDA to collect user fees for the review of 
certain premarket submissions received on or after October 1, 2012, including premarket 
notification submissions (510(k)s).  The additional funds obtained from user fees will enable 
FDA, with the cooperation of industry, to improve the device review process to meet certain 
performance goals and implement improvements for the medical device review process. 
 
                                                           
1 An applicant is the same as a holder, sponsor, or submitter for the purposes of this guidance document. 
2 See 
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/Overview/MedicalDeviceUserFeea
ndModernizationActMDUFMA/UCM109102.pdf. 
3 See the Food and Drug Administration Safety and Innovation Act (FDASIA, Public Law 112-114) 
1  Contains Nonbinding Recommendations 
 
During discussions with representatives of the medical device industry in the development of the 
Agencys recommendations for MDUFA III,4 the Agency proposed process improvements to 
provide further transparency for the review process, including new communication 
commitments.  These additional communications are in the context of:  acceptance review;5 
substantive interactions; and, if applicable, missed MDUFA goals.  These communications are 
outlined in the MDUFA III Commitment Letter6 and are further described in this guidance.  In 
addition, this guidance updates the Agencys approach to Interactive Review to reflect FDAs 
commitments in the MDUFA III Commitment Letter and to incorporate an expanded use of this 
communication tool to increase the efficiency of the review process. 
 
FDA's guidance documents, including this guidance, do not establish legally enforceable 
responsibilities.  Instead, guidances describe the Agency's current thinking on a topic and should 
be viewed only as recommendations, unless specific regulatory or statutory requirements are 
cited.  The use of the word should in Agency guidance documents means that something is 
suggested or recommended, but not required. 
 
2. Scope  
This guidance describes four types of communication that occur during the review of a medical 
device submission.  The four types of communication and the submissions to which they apply 
are: 
  Acceptance Review Communication for premarket notification submissions (510(k)s),7 
original premarket approval applications (Original PMAs), Panel-Track PMA 
Supplements, and Pre-Submissions;8,9,10,11  
                                                           
4 Meeting minutes from discussions with the medical device industry on the development of the Agencys 
recommendations for MDUFA III are available at 
http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/Overview/MedicalDeviceUserFeeandModerniz
ationActMDUFMA/ucm236902.htm. 
5 FDA has issued guidance on acceptance review: Refuse to Accept Policy for 510(k)s available at 
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM315014.
pdf and Acceptance and Filing Review for Premarket Approval Applications (PMAs) available at 
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM313368.
pdf.  
6 MDUFA III Commitment Letter, available at 
http://www.fda.gov/downloads/MedicalDevices/NewsEvents/WorkshopsConferences/UCM295454.pdf (this 
document is dated April 18, 2012; it has not changed since then).   
7 Acceptance review applies to traditional, special, and abbreviated 510(k) submissions; however, it does not apply 
to Third Party 510(k)s. 
8 Wherever Original PMAs and Panel-Track PMA Supplements are discussed, the discussion also applies to 
Premarket Report Applications.  These applications are not explicitly referenced in the body of this document given 
the limited number that FDA receives each year.   
9 Note that as described in the guidance Acceptance and Filing Review for Premarket Approval Applications 
(PMAs), original PMAs and Panel-Track PMA supplements will also undergo a filing review, once accepted, and 
the outcome of the filing review (i.e., Filed or Not Filed) will be communicated to the applicant.  See 21 CFR 
814.42. 
10 The MDUFA III Commitment Letter does not include this type of communication for Biologics License 
Application (BLA) submissions for medical devices.  However, BLA submissions for medical devices are subject to 
Refuse to File (RTF) criteria and processes; please refer to 21 CFR 601.2(a), CBER SOPP 8401.3: Filing Action: 
Communication Options at 
2  Contains Nonbinding Recommendations 
 
  Substantive Interaction10 for 510(k)s, Original PMAs, Panel-Track PMA Supplements, 
and 180-Day PMA Supplements;  
  Interactive Review; and 
  Missed MDUFA Decision Communication10 for 510(k)s, Original PMAs, and Panel-
Track PMA Supplements. 
 
Appeals (including requests for dispute resolution),12 and general policy discussions are not 
within the scope of this guidance document.   
 
3. Acceptance Review Communication 
a.  Purpose of Acceptance Review Communication 
The purpose of the Acceptance Review Communication is to:  (1) identify the lead reviewer or 
Regulatory Project Manager13 assigned to the submission and (2) confirm acceptance of the 
submission or notify the submitter that the submission was not accepted based upon the review 
of the submission against objective acceptance criteria.  FDA has issued guidance documents on 
acceptance review: Refuse to Accept Policy for 510(k)s, available at 
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocu
ments/UCM315014.pdf, and Acceptance and Filing Review for Premarket Approval 
Applications (PMAs), available at 
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocu
ments/UCM313368.pdf.   
 
b. Timing of Acceptance Review Communication 
The Acceptance Review Communication should occur within 15 days14 of receipt of a 510(k), 
Original PMAs, or a Panel-Track PMA Supplement and within 14 days of receipt of a Pre-
Submission.   
 
Please note that the Acceptance Review does not start until FDA has received a valid eCopy and, 
if applicable, the user fee has been paid.15 
                                                                                                                                                                                           
http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/ProceduresSOPPs/ucm0
73085.htm, and CBER SOPP 8404: Refusal to File Procedures for Biologic License Applications at 
http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/ProceduresSOPPs/ucm0
73474.htm. 
11 See the draft guidance entitled, The Pre-Submission Program and Meetings with FDA Staff, available at 
http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm310375.htm.  FDA 
draft guidance represents FDAs current approach to this issue. 
12 See the guidance entitled, CDRH Appeals Processes, available at 
http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm284651.htm. 
13 All references to lead reviewer in this guidance document are specific to CDRH.  For CBER, in all cases, the 
appropriate contact person is the regulatory project manager (RPM).   
14 For the purposes of this guidance, all days refer to calendar days. 
15 See the guidance, eCopy Program for Medical Device Submissions, at 
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM313794.
pdf. 
3  Contains Nonbinding Recommendations 
 
c.  Content of Acceptance Review Communication 
FDA should communicate the outcome of the Acceptance Review to the applicant by fax, email, 
or other written communication.  This communication represents a review of the submission for 
completeness and is not intended to identify deficiencies that may be identified later in the 
review cycle. 
 
(1)  When the submission is accepted 
FDA should provide the name of the FDA lead reviewer or Regulatory Project Manager 
and notify the applicant that the submission has been accepted.  For a 510(k) and Pre-
Submission, the submission is accepted for substantive review.  For an Original PMA or 
Panel-Track PMA Supplement, the submission is accepted for filing review.16 
 
(2)  When the submission is not accepted  
FDA should provide the name of the FDA lead reviewer or Regulatory Project Manager 
and notify the applicant that the submission has not been accepted and identify those 
items necessary for the submission to be considered accepted.   
 
4. Substantive Interaction 
a.  Purpose of Substantive Interaction 
Substantive Interaction is one of the following actions: 
  FDA notification that we intend to continue working with the applicant to resolve any 
outstanding deficiencies via Interactive Review, and the submission will not be placed on 
hold; or 
  FDA notification placing the submission on hold and identifying the deficiencies to be 
addressed in order for substantive review to continue. 
 
b. Timing of Substantive Interaction 
Substantive Interaction should occur following acceptance of the submission and after FDA has 
performed a complete review17 of the submission and within: 
  60 days of the receipt date of a complete submission for 510(k)s; 
  90 days of the filing date for Original PMAs and Panel-Track PMA Supplements; and 
  90 days of the receipt date for 180-Day PMA Supplements. 
                                                           
16 For those PMA submissions that are accepted for filing review, FDA will communicate the filing status within 45 
calendar days of receipt of a complete application.  See 21 CFR 814.42.  For those applications that are not filed, 
FDA intends to communicate the specific reasons for rejection and the information necessary for filing.  See the 
guidance document entitled Acceptance and Filing Reviews for Premarket Approval Applications, available at 
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM313368.
pdf. 
17 In some cases, a complete review for a 510(k) may not be warranted because FDA has determined that there is a 
new intended use or technological difference that raises a new question of safety and effectiveness.  
4  Contains Nonbinding Recommendations 
 
 
Note that the timeframes for Substantive Interaction include the 15 days used for the Acceptance 
Review. 
 
An approval, approvable, or clearance letter issued prior to the Substantive Interaction goal date 
is considered an on-time Substantive Interaction for the purpose of meeting the MDUFA III 
goal. 
 
c.  Content of Substantive Interaction 
Based on the nature and/or extent of the deficiencies, the submission may or may not be placed 
on hold.   
(1)  When the submission is not placed on hold  
 
FDA should inform the applicant via email or fax that, based on a complete review of the 
entire submission, the agency does not intend to place the submission on hold and that 
any additional deficiencies will be handled through Interactive Review.  This type of 
Substantive Interaction has no start/stop impact on the review clock. 
 
(2)  When the submission is placed on hold  
 
FDA intends to place the submission on hold in accordance with current practice.18,19  
Deficiencies identified in the hold notification should be based upon a complete review 
of the entire submission, and should include both major and any unresolved minor 
deficiencies.20  
 
5. Interactive Review  
a.  Purpose of Interactive Review 
The purpose of the Interactive Review process is to facilitate the efficient and timely review and 
evaluation by FDA of premarket submissions through increased informal interaction between 
FDA and applicants, including the exchange of scientific and regulatory information.  More 
specifically, the Interactive Review process is designed to help accomplish the following: 
  improve the interaction between the FDA review staff and the applicant during the 
review process; 
                                                           
18 For information regarding the effect of agency and industry actions pertaining to premarket review of 510(k)s on 
the FDA review clock and MDUFA goals, refer to the guidance document entitled, FDA and Industry Actions on 
Premarket Notification (510(k)) Submissions: Effect on FDA Review Clock and Goals," available at 
http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm089735.htm). 
19 For information regarding the effect of agency and industry actions pertaining to premarket review of PMAs on 
the FDA review clock and MDUFA goals, refer to the guidance document entitled, FDA and Industry Actions on 
Premarket Approval Applications (PMAs): Effect on FDA Review Clock and Performance Assessment, available 
at http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm089733.htm. 
20 For PMAs, the hold letter may not include all minor deficiencies associated with labeling and post-approval 
studies as these items cannot typically be fully reviewed until the major deficiencies have been successfully 
addressed. 
5  Contains Nonbinding Recommendations 
 
  prevent unnecessary delays in the completion of the review, thus reducing the overall 
time to market; 
  ensure that FDAs concerns are clearly communicated to the applicant during the review 
process, as appropriate; 
  minimize the number of review cycles; 
  minimize the number of review questions conveyed through deficiency letters; and  
  ensure timely responses from applicants.   
 
b. Timing and Expectations for Interactive Review 
There are different expectations for Interactive Review depending on when, during FDAs 
review of the submission, the need to communicate occurs.  
 
(1)  Interactive Review After Substantive Interaction for 510(k)s, Original PMAs, 
Panel-Track PMA Supplements, and 180-Day PMA Supplements 
 
  FDA intends to engage in Interactive Review after Substantive Interaction. 
 
(2)  Additional Interactive Review  
 
FDA encourages the use of Interactive Review at other points in the review process to 
facilitate the efficient and timely review of medical device submissions.  More 
specifically, at FDAs discretion, Interactive Review can be used: 
 
  prior to Substantive Interaction for 510(k)s, Original PMAs, Panel-Track PMA 
Supplements, and 180-Day PMA Supplements; and 
 
  as needed for other submission types, such as:   
  other PMA submissions (Real-Time Supplements, Special Supplements, 30-
o
Day Notices/135-Day Supplements, Manufacturing Site Change Supplements, 
Post-Approval Study Supplements, Annual Reports, Post-Approval Study 
Reports); 
  Pre-Submissions; 
o
  Third Party 510(k)s; 
o
  Evaluation of Automatic Class III Designations (de novo petitions); 
o
  513(g) submissions; 
o
  Original BLAs and BLA supplements; 
o
  Humanitarian Device Exemption (HDE) applications;  
o
  Investigational Device Exemptions (IDEs); and 
o
  Product Development Protocols (PDPs). 
o
c.  Types of Deficiencies Appropriate for Interactive Review 
FDA has found that Interactive Review can be used more broadly than was suggested by our 
previous guidance on this subject, which this guidance supersedes, Interactive Review for 
6  Contains Nonbinding Recommendations 
 
Medical Device Submissions: 510(k)s, Original PMAs, PMA Supplements, Original BLAs, and 
BLA Supplements.  The initial guidance indicated that only minor deficiencies (e.g., those 
deficiencies that, if unaddressed, could be communicated in a PMA approvable letter) would be 
considered appropriate for Interactive Review.  Since then, FDA has found that the benefits of 
Interactive Review could be expanded by using Interactive Review to address deficiencies that 
are more significant than minor, but could likely be addressed by the applicant in a time frame 
that would allow FDA review of the response prior to the MDUFA performance goal for that 
submission type21 without placing the submission on hold.  Examples include, but are not limited 
to: requests for limited additional short-term laboratory bench or biocompatibility testing; further 
justification for the omission of a test; and additional statistical analysis of the clinical data not 
related to the primary safety or effectiveness endpoint.  FDA review staff should obtain 
appropriate management input and approval prior to communication of any deficiencies. 
 
d. The Interactive Review Process 
Interactive Review, by definition, occurs when the submission is under review.22  Interactive 
Review has no start/stop impact on the review clock. 
 
Whenever Interactive Review is used, FDA should determine an acceptable timeframe for the 
applicant to provide a response to the deficiencies based on MDUFA, Office, or Center 
timelines.  The established timeframe should be based on the impending review deadline, the 
estimated time that the applicant should need to respond, and the estimated time that FDA should 
need to review the response.  FDA should clearly communicate the due date for responding to 
the Interactive Review request.   
 
As the end of the review cycle approaches, FDA intends to communicate the remaining issues, 
limiting the applicants response timeframe to a time specified by FDA, not to exceed 7 calendar 
days and allowing time for FDA to review the response, so that a timely MDUFA decision can 
be made.   
 
If the submission was previously on hold, then any new deficiencies (i.e., deficiencies not raised 
as part of the hold notification) should be limited to issues raised by the information provided by 
the applicant in its response, unless the reviewer concludes (and received supervisory 
concurrence) that the initial deficiencies identified do not adequately address important issues 
materially relevant to a decision of substantial equivalence (510(k)) or safety and effectiveness 
(PMA).23  For example, following the communication of deficiencies in a 510(k) AI letter, FDA 
                                                           
21 Performance goals for each submission type are addressed in the guidance documents, FDA and Industry 
Actions on Premarket Notification (510(k)) Submissions: Effect on FDA Review Clock and Goals. 
(http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm089735.htm) and 
FDA and Industry Actions on Premarket Approval Applications (PMAs): Effect on FDA Review Clock and 
Goals 
(http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm089733.htm). 
22 Although Interactive Review takes place when the submission is under review, FDA will interact with the 
applicant when the submission is on hold in order to clarify any deficiencies.  As warranted, a Submission Issue 
Meeting request or a Pre-Submission may be needed to provide feedback on more than brief clarification questions. 
23 For more information on requests for additional information pertaining to subsequent interactions, refer to the 
CDRH SOP entitled, SOP: Decision Authority for Additional or Changed Data Needs for Premarket Submissions, 
available at 
7  Contains Nonbinding Recommendations 
 
might become aware of a heightened potential for device failure through a series of recalls on 
other devices with a similar feature.  If these recalls indicate that the particular bench test 
performed by the applicant to evaluate this feature is not predictive of clinical performance, an 
FDA reviewer, with appropriate supervisory concurrence, might request additional testing to 
address the safety of this feature to determine substantial equivalence.   
 
Please note that if the outstanding deficiencies are not likely to be resolved through Interactive 
Review (e.g., a device submitted in a 510(k) has a new intended use or different technological 
characteristics that raise new questions of safety or effectiveness; a new clinical study will be 
needed for a device submitted in a PMA), FDA may proceed with a MDUFA decision without 
engaging in Interactive Review (e.g., issuing a Not Substantially Equivalent (NSE) letter for a 
510(k) or a Not Approvable (NOAP) letter for a PMA). 
 
In limited circumstances and at our discretion, a second AI letter for a 510(k) may be 
appropriate.  One example of such a circumstance would be when a first AI letter indicates that 
FDA believes that the proposed predicate is not appropriate, but the submitter is then able to 
identify a different, but appropriate predicate.  A subsequent review of the comparison of the 
subject device to the newly identified predicate could raise questions appropriate for a second AI 
request.  FDA has two reasons for limiting the circumstances under which FDA will consider 
issuing a second AI letter, as opposed to an NSE letter.  First, where the applicant should know 
what data are needed for its device to meet the applicable review standards (e.g., because of 
guidance, web-posted 510(k) summaries), the initial submission should be complete, and, 
therefore, a second hold letter would be contrary to the stated goal of MDUFA III to reduce the 
number of review cycles and the Total Time to Decision.24  Second, when such information is 
not available (e.g., guidance is not clear or the device incorporates a new technology or feature), 
the applicant should have utilized the Pre-Submission Program25 to obtain FDAs 
recommendations for the planned submission. 
 
e.  Communication Tools for Interactive Review 
Communication tools that should facilitate Interactive Review are described below.  Application 
of these communication tools should remain flexible to balance speed and efficiency with the 
need to ensure appropriate FDA supervisory concurrence.  Appropriate communication tools for 
Interactive Review include the following:26 
 
  Email and Fax27,28 - FDAs preferred mechanisms for communication are email and fax 
because they are efficient and create a permanent record of the interaction.   
                                                                                                                                                                                           
http://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDRH/CDRHReports/ucm27
9288.htm. 
24 The term Total Time to Decision is defined in the MDUFA III Commitment Letter, See footnote 6. 
25 FDA has issued draft guidance on Pre-Submissions, entitled, The Pre-Submission Program and Meetings with 
FDA Staff available at 
http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm310375.htm. Once 
final, this document will represent the FDAs thinking on this topic. 
26 FDA does not intend to issue letters as part of the Interactive Review process and, accordingly, information 
regarding letters was removed from the Interactive Review section of this updated guidance. 
27 All email communications, including during interactive review, between industry and FDA (in both directions) 
are unencrypted (not secure) unless regulated firms and/or their representatives have taken steps to create a secure 
email communication channel with the Agency.  Some companies in the medical device industry have already taken 
8  Contains Nonbinding Recommendations 
 
 
  Phone Calls29,30 - Phone calls should be used primarily for requests for clarification that 
the FDA reviewer can easily document (e.g., the location of specific information within 
the submission, interpretation of a graph).   
 
f.  Responses to Deficiencies Requested via the Interactive Review Process 
FDA should accept email responses to the information requested via the Interactive Review 
process and include that information as part of the official administrative file for the submission.  
FDA should not request that the applicant also formally submit these Interactive Review 
responses to the appropriate Document Control Center (DCC) as part of an official submission.  
 
Please note that eCopy requirements do not apply to information obtained during the 
Interactive Review process (via email, phone, and/or fax) once a submission is under 
review, if that information is not submitted to CDRHs or CBERs DCC.  However, should 
an applicant choose to submit a response to an Interactive Review request to CDRHs or 
CBERs DCC [which should only occur if the size of the response makes communication by 
email (no individual email should exceed 50MB) or fax infeasible], it will be logged in as an 
amendment and be subject to the eCopy requirements.31   
 
g.  Applicants Role in the Interactive Review Process 
(1)  What the Applicant Can Do to Help Ensure an Efficient Interactive Review 
Process 
To help ensure that the Interactive Review process is effective, the applicant should do the 
following: 
                                                                                                                                                                                           
the steps necessary to establish secure email communications, but many others have not.  Companies wishing to 
establish secure email communications with FDA should send an email to SecureEmail@fda.hhs.gov.  The 
Agencys Office of Information Management will contact the sender to let them know what they need to do, or what 
they need to pass on to their IT support person/group to establish this secure communications link.  It is important to 
note that, regardless of whether or not a company establishes encrypted email communications with FDA, the 
communications are treated as confidential by FDA staff. 
28 Please note that secure email is the preferred option for CBER.  See the following CBER Standard Operating 
Procedures and Policies for more information: SOPP 8113: Handling of Regulatory Faxes available at 
http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/ProceduresSOPPs/ucm0
79472.htm and SOPP 8119: Use of Email for Regulatory Communications available at 
http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/ProceduresSOPPs/ucm1
09645.htm. 
29 See the following CBER Standard Operating Procedures and Policies for more information: SOPP 8104: 
Documentation of Telephone Contacts with Regulated Industry available at 
http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/ProceduresSOPPs/ucm0
79463.htm. 
30 CDRH staff should include documentation of the teleconference (including the names of the participants, date and 
time held, and substantive issues discussed) through an email to the document management system.  
31 For more information about the eCopy program, see the guidance, eCopy Program for Medical Device 
Submissions, at 
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM313794.
pdf. 
9  Contains Nonbinding Recommendations 
 
  submit a well organized and administratively and scientifically complete submission 
consistent with applicable regulations, recommendations in the available guidance 
documents, and communications with FDA prior to submission;   
  include complete contact information in the cover letter (i.e., name, email, phone 
number, fax number) in the company cover letter for each submission.  FDA also 
recommends providing alternative contact information in case the lead contact is not 
available.  In addition, foreign applicants should have a U.S. representative32 
available to participate in the Interactive Review process and to provide a means to 
contact the foreign company as quickly as possible; 
  apply appropriate material or testing standard(s) and submit the necessary 
declarations or data to support the use of the standard(s); and 
  provide a complete response to all deficiencies communicated via Interactive Review 
within the FDA-allotted timeframe 
(2)  Examples of When the Applicant Should Contact the Lead Reviewer [CDRH] or 
Regulatory Project Manager [CBER] 
Examples of when the applicant should contact the lead reviewer or Regulatory Project 
Manager (RPM) of the submission include the following:33 
  to reconcile any disagreement with a deficiency cited by the lead reviewer or 
consulting reviewer during Interactive Review; 
  to inquire whether a revised Interactive Review timeframe may be given to address a 
deficiency because the initial timeframe cannot be met (this does not pertain to our 
last Interactive Review communication at the end of the review cycle, which we 
intend to limit to 7 calendar days);  
  to discuss procedural questions related to the submission; 
  to correct errors in the data submitted; 
  to clarify information in the submission that the applicant subsequently notices is 
unclear; and 
  to alert FDA that it intends to submit new, unsolicited information or data (depending 
on its extent, the information/data may necessitate a new submission or be logged in 
as an amendment to an existing submission). 
 
                                                           
32 If a PMA applicant does not reside or have a place of business within the U.S., the PMA must be countersigned 
by an authorized representative residing or maintaining a place of business in the U.S. and must identify the 
representatives name and address (21 CFR 814.20(a)).  Identification of and contact information for a U.S. agent is 
required for all foreign device manufacturers when they register and list with FDA (21 CFR 607.40(d) and 21 CFR 
807.40(b)).  To facilitate timely communication, it is recommended that a U.S. representative be included for all 
submission types, in addition to PMAs.  
33 The examples are specific to the Interactive Review process when the submission is under review.   
10  Contains Nonbinding Recommendations 
 
Applicants should refrain from using Interactive Review to request status updates as such 
requests may interfere with FDAs ability to meet applicable timeframes. 
 
h. FDA Review Team Considerations 
FDA consulting reviewers, like the lead reviewer, should participate in the Interactive Review of 
submissions.  However, the lead reviewer/RPM should determine whether or not a consulting 
reviewer should communicate directly with the applicant or communicate to the applicant 
through the lead reviewer/RPM to resolve minor deficiencies.   
 
In cases where a consulting reviewer communicates directly with the applicant on a particular 
deficiency, a documented record of the exchange should be made available to the lead 
reviewer/RPM (e.g., cc on an email).  The consulting reviewer is also expected to document 
any interaction as part of his/her review record back to the lead reviewer/RPM.  
 
6. Missed MDUFA Decision Communication 
a.  Purpose of Missed MDUFA Decision Communication 
The purpose of this communication is to facilitate a timely resolution to any outstanding issues 
that have precluded FDA from reaching a MDUFA decision prior to the appropriate MDUFA 
decision goal. 
 
b. Timing of Missed MDUFA Decision Communication 
A Missed MDUFA Decision communication should occur for those submissions that have not 
reached a MDUFA decision by: 
  100 FDA days for 510(k)s; and 
  20 FDA days after the applicable FDA day goal for Original PMAs and Panel-Track 
PMA Supplements. 
 
c.  Content of Missed MDUFA Decision Communication 
FDA intends to provide written (e.g., email) feedback to be discussed in a meeting or 
teleconference.  The feedback should reflect appropriate management input and approval and 
should include: 
  all outstanding issues with the application preventing FDA from reaching a decision;34 
  action items for FDA and/or the applicant; 
  the estimated completion date for the action items identified for each party; and 
                                                           
34 Note that issues in this context refers to the major outstanding review topic areas or other reasons that are 
preventing FDA from reaching a MDUFA decision and not necessarily to individual deficiencies.  Any specific 
outstanding deficiencies that preclude approval should not be included in this communication, but should be 
communicated informally through Interactive Review or formally in a MDUFA decision letter.   
11  Contains Nonbinding Recommendations 
 
  proposed dates for meetings from which the applicant may choose (the applicant may, in 
turn, propose alternative dates to FDA). 
 
Outstanding issues should be resolved through Interactive Review whenever possible.  If all of 
the outstanding issues are adequately presented through the written correspondence, FDA and 
the applicant can agree that a meeting or teleconference is not necessary. 
12