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 54

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 3455 FDA Form 3455 0396_FDA_3455.pdf Yes Yes Fillable Printable

Health Consumer Health and Safety

 

72 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 72 0 0 -33 0 105
Annual IC Time Burden (Hours) 360 0 0 -165 0 525
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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