Information Collection

Conflict of Interest Form

IC 238003 under ICR 202211-0910-002 · OMB 0910-0882.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FDA Form 4083 Conflict of Interest Form	Form and Instruction
FDA Form 4083 Report of Financial Interests and Other Relationships fo 0882_FDA Form 4083.pdf	Form and Instruction
FDA Form 4083 Report of Financial Interests and Other Relationships fo 0882_FDA Form 4083.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FDA Form 4083	Report of Financial Interests and Other Relationships for Non-Employee Scientists at FDA	0882_FDA Form 4083.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,050

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,050	1,050
Annual IC Time Burden (Hours)	1,050	1,050
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.