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TO BE COMPLETED BY INVESTIGATOR. Collection of this information is authorized under 21 CFR 54.4. The use of this information is to disclose or certify information concerning the financial interests of the clinical investigators associated with clinical studies.
Form FDA 3454, or the Financial Certification or Disclosure Statement, is used to submit information regarding clinical investigators who participated in the clinical studies. If no clinical studies were performed, simply state: \u201cno clinical studies were performed to test this device.\u201d
applicants may submit a single FORM FDA 3455, with attachments clearly identifying all clinical investigators with information to disclose and, for each investigator, identifying the study, the specific details of their financial interests and arrangements and the steps taken to minimize the potential for bias.
Form FDA 3674 - Certifications To Accompany Drug, Biological Product, and Device Applications/Submissions Guidance for Sponsors, Industry, Researchers, Investigators, and Food and Drug Administration Staff June 2017.
What is a FDA Form 1571? The FDA Form 1571 or '1571' is the IND application cover page and it must accompany the initial IND submission and any amendments, IND safety reports, annual reports or general correspondence the sponsor submits to the FDA about the IND.
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Financial interest of a clinical investigator is one potential source of bias in the outcome of a clinical study. To ensure the reliability of the data, the financial interests and arrangements of clinical investigators must be disclosed to FDA.
Form FDA 3454, or the Financial Certification or Disclosure Statement, is used to submit information regarding clinical investigators who participated in the clinical studies. If no clinical studies were performed, simply state: \u201cno clinical studies were performed to test this device.\u201d
Complete form 3454 if none of the investigators have any FDA required disclosures. Complete form 3455 if any clinical investigator has a financial disclosure that is significant.
applicants may submit a single FORM FDA 3455, with attachments clearly identifying all clinical investigators with information to disclose and, for each investigator, identifying the study, the specific details of their financial interests and arrangements and the steps taken to minimize the potential for bias.
TO BE COMPLETED BY INVESTIGATOR. Collection of this information is authorized under 21 CFR 54.4. The use of this information is to disclose or certify information concerning the financial interests of the clinical investigators associated with clinical studies.

form 3674 pdf