Financial Disclosure by Clinical Investigators

ICR 202504-0910-011

OMB: 0910-0396

Federal Form Document

Forms and Documents

Document Name	Status
Form 3454 Certification--54.4(a)(1) and (a)(2)--Form FDA 3454 Form	Modified
Form 3455 Disclosure--54.4(a)(3)--Form FDA 3455 Form	Modified
0396_Supporting Statement_2025.docx Supporting Statement A	2025-04-30

IC Document Collections

IC ID	Document Title	Status
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	Modified