Information Collection

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

IC 188971 under ICR 202504-0910-011 · OMB 0910-0396.

Documents and Forms

Document Name Document Type
Form 3455 Disclosure--54.4(a)(3)--Form FDA 3455 Form
Form 3455 DISCLOSURE: FINANCIAL INTERESTS AND ARRANGEMENTS OF CLINICAL INVESTIGATORS Disclosure--54.4(a)(3)--Form FDA 3455 Form
3455 DISCLOSURE: FINANCIAL INTERESTS AND ARRANGEMENTS OF CLIN FDA_3455_DISCLOSURE - FINANCIAL INTERESTS AND ARRANGEMENTS OF CLINICAL INVESTIGATORS.pdf Form
3455 DISCLOSURE: FINANCIAL INTERESTS AND ARRANGEMENTS OF CLIN FDA_3455_DISCLOSURE - FINANCIAL INTERESTS AND ARRANGEMENTS OF CLINICAL INVESTIGATORS.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Disclosure--54.4(a)(3)--Form FDA 3455	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 21 CFR 54

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3455	DISCLOSURE: FINANCIAL INTERESTS AND ARRANGEMENTS OF CLINICAL INVESTIGATORS	FDA_3455_DISCLOSURE - FINANCIAL INTERESTS AND ARRANGEMENTS OF CLINICAL INVESTIGATORS.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 71	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	71	-1	72
Annual IC Time Burden (Hours)	355	-5	360
Annual IC Cost Burden (Dollars)	0	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.

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