Conflict of Interest Form

Collection of Conflict of Interest Information for Participation in Food and Drug Administration Non-Employee Fellowship and Traineeship Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0882 can be found here:

Documents and Forms

Document Name Document Type
Final Collection form for financial interests and other relationships.pdf Other-Report of Financial and Other

Information Collection (IC) Details

IC Title:	Conflict of Interest Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-Report of Financial and Other Relationships for Non-Employee Scientists at FDA Form			Final Collection form for financial interests and other relationships.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 %

	Approved	Change Due to Adjustment in Agency Estimate
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

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.