Information Collection Request

Financial Disclosure by Clinical Investigators

ICR 202504-0910-011 · OMB 0910-0396 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 3454 CERTIFICATION: FINANCIAL INTERESTS AND ARRANGEMENTS OF CLINICAL INVESTIGATORS Form Modified Available
Form 3454 Certification--54.4(a)(1) and (a)(2)--Form FDA 3454 Form Modified Repair queued
Form 3455 DISCLOSURE: FINANCIAL INTERESTS AND ARRANGEMENTS OF CLINICAL INVESTIGATORS Form Modified Available
Form 3455 Disclosure--54.4(a)(3)--Form FDA 3455 Form Modified Repair queued
0396_Supporting Statement_2025.docx Supporting Statement A Uploaded 2025-04-30 Available
0396_Supporting Statement_2025.docx Supporting Statement A Uploaded 2025-04-30 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
6057 Certification--54.4(a)(1) and (a)(2)--Form FDA 3454 Form ModifiedCERTIFICATION: FINANCIAL INTERESTS AND ARRANGEMENTS OF CLINICAL INVESTIGATORS
6057 Certification--54.4(a)(1) and (a)(2)--Form FDA 3454 Form Modified
188973 Recordkeeping--54.6 Modified
188972 54.4(b)--Clinical Investigators Third Party Disclosure Modified
188971 Disclosure--54.4(a)(3)--Form FDA 3455 Form ModifiedDISCLOSURE: FINANCIAL INTERESTS AND ARRANGEMENTS OF CLINICAL INVESTIGATORS
188971 Disclosure--54.4(a)(3)--Form FDA 3455 Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2028 36 Months From Approved 07/31/2025
15,141 0 14,584
3,565 0 3,478
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
54.4(b)--Clinical Investigators Third Party Disclosure
Certification--54.4(a)(1) and (a)(2)--Form FDA 3454 3454
Disclosure--54.4(a)(3)--Form FDA 3455 3455
Recordkeeping--54.6

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 15,141 14,584 0 0 557 0
Annual Time Burden (Hours) 3,565 3,478 0 0 87 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No