Financial Disclosure Form

Investigator Registration and Financial Disclosure for Investigational Trials in Cancer Treatment (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0613 can be found here:

Documents and Forms

Document Name Document Type
Form 3 Financial Disclosure Form Form and Instruction
3 Financial Disclosure Form Attachment 3_Financial_Disclosure_Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Financial Disclosure Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	Financial Disclosure Form	Attachment 3_Financial_Disclosure_Form.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17,128	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	17,128	17,128
Annual IC Time Burden (Hours)	1,427	1,427
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.