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Conflict of Interest Form
Collection of Conflict of Interest Information for Participation in Food and Drug Administration Non-Employee Fellowship and Traineeship Programs
OMB: 0910-0882
IC ID: 238003
OMB.report
HHS/FDA
OMB 0910-0882
ICR 202211-0910-002
IC 238003
( )
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Conflict of Interest Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection 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
Federal Enterprise Architecture Business Reference Module
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 %
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
1,050
0
0
0
0
1,050
Annual IC Time Burden (Hours)
1,050
0
0
0
0
1,050
Annual IC Cost Burden (Dollars)
0
0
0
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.