Disclosure Statement For Conflict Of Interest: Federal Grants

By the time an application is submitted to either the Public Health Service (PHS) or National Science Foundation (NSF), each Investigator who is planning to participate in the funded research is required to submit to the Associate Provost or his or her designee a listing of his or her known Significant Financial Interests (and those of his or her spouse and dependent children):

(i) That would reasonably appear to be affected by the research or educational activity for which funding is sought; and

(ii) In entities whose financial interests would reasonably appear to be affected by the research or educational activity.

Disclosure is not required if the application is for a subaward under the National Institutes of Health SBIR/STTR Phase I funding.

All financial disclosures must be updated during the period of the award, either on an annual basis or as new reportable Significant Financial Interests are obtained. No funds may be expended until the process of identifying and managing any conflicts is complete. If the Investigator has no Significant Financial Interests to disclose, the Investigator is required to certify the lack of such interests.

What follows is a sample disclosure statement. For a fillable form click here
Disclosure Statement for RISD Researchers

PHS/HHS/NSF Disclosure Statement for RISD Researchers

Required Disclosure: Each time an application is submitted to either the Public Health Service/U.S. Department of Health and Human Services or the National Science Foundation, each Investigator who is planning to participate in the funded research is required to submit to the Vice Provost or his or her designee a listing of his or her known Significant Financial Interests associated with the proposed research (and those of his or her spouse and dependent children).

Certification: I hereby certify that I have read and understand the Conflict of Interest Policy for RISD Researchers Working Under Federal Grants and Cooperative Agreements. I am disclosing the following significant financial interests (check one or more) and attach supporting documents (in an envelope marked confidential) that identify the business entity or enterprise involved and the nature and amount of the interest.

Significant financial interests are defined in the college’s policy as anything of monetary value, including but not limited to:

_____Salary or other payment for services exceeding ten thousand dollars ($10,000) over the next twelve months (e.g., consulting fees or honoraria; does not include remuneration from RISD);

_____Equity interests exceeding ten thousand dollars ($10,000) and representing more than five percent ownership interest in any single entity (e.g., stocks, stock options, or other ownership interests);

_____Intellectual property rights expected to exceed ten thousand dollars ($10,000) over the next twelve months (e.g., patents, copyrights, and royalties from such rights);

_____Other interests that would reasonably appear to be affected by the research or educational activities funded or proposed for funding, or interests in entities that would reasonably appear to be affected by the research or educational activities.

If there is no significant financial interest to disclose, please check here:

Further I agree:

To update this disclosure during the period of the award, either on an annual basis, or as new reportable significant financial interests are obtained. I also agree to cooperate in the development of a plan to resolve any conflicts of interest, and to comply with any conditions or restrictions imposed by the college to manage, reduce, or eliminate actual or potential conflicts of interest or to forfeit the award.

Signature ­­­­­­­______________________________________________ Date

Name (print)

Department

Proposal Title

Proposal Submission Deadline

Sponsoring Agency/Funding Source

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