FDA Form 3455 Financial Disclosure-2026

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The document is a form from the Department of Health and Human Services, specifically the Food and Drug Administration (FDA), that requires clinical investigators to disclose their financial interests and arrangements related to a clinical study. It outlines the types of financial relationships that must be reported, including compensation influenced by study outcomes, significant payments, proprietary interests in tested products, and equity interests in the sponsoring organization. The form also includes instructions for completing it and notes on compliance with the Paperwork Reduction Act.

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Click ‘Get Form’ to open the form in the editor.
Begin by entering the name of the clinical investigator in the designated field. This is crucial for identifying who participated in the study.
Next, fill in the name of the clinical study. Ensure accuracy as this links back to the investigator's disclosures.
Review and mark any applicable checkboxes regarding financial arrangements or interests. Each option pertains to different types of financial relationships that must be disclosed.
Attach any additional details regarding disclosable financial arrangements and interests as required. This may include descriptions of steps taken to minimize bias.
Complete the title, name, firm/organization, and signature fields at the bottom of the form. Don’t forget to enter the date in mm/dd/yyyy format.

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Versions	Form popularity	Fillable & printable
2022	4.5 Satisfied (47 Votes)
2009	4.8 Satisfied (24 Votes)

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fda form 3455

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