Disclosure--54.4(a)(3)--Form FDA 3455

Financial Disclosure by Clinical Investigators

OMB: 0910-0396

IC ID: 188971

Information Collection (IC) Details

View Information Collection (IC)

Disclosure--54.4(a)(3)--Form FDA 3455
 
No Modified
 
Mandatory
 
21 CFR 301

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 3455 FDA Form 3455 FDA 3455 exp 12-31-15.pdf Yes Yes Fillable Printable

Health Public Health Monitoring

 

100 0
   
Individuals or Households
 
   10 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100 0 0 10 0 90
Annual IC Time Burden (Hours) 500 0 0 50 0 450
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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