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DEPARTMENT OF HEATH AND HUMAN SERVICES Commissioned Corps of the U.S. Public Health Service ASSIGNMENT INCENTIVE PAY (AIP) CONTRACT REQUEST (Privacy Act Notice on Page 2) IDENTIFICATION Name (Last,
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The PHS 7065 form is a reporting form used by certain entities to disclose financial interests that may pose a potential conflict of interest in research funded by the Public Health Service (PHS).
Individuals who are employed or affiliated with an institution that receives PHS funding and who are involved in PHS-funded research are required to file the PHS 7065 form if they have a financial interest that meets the reporting thresholds defined by the institution's policy and federal regulations.
The process for filling out the PHS 7065 form may vary depending on the specific institution's requirements. Generally, individuals are required to disclose their financial interests, including the nature of the interest, the value, and the duration. It is recommended to consult the institution's policies and guidance for detailed instructions.
The purpose of the PHS 7065 form is to identify and manage potential conflicts of interest in research funded by the Public Health Service. By disclosing financial interests, institutions can ensure that the research is conducted in an objective and unbiased manner, maintaining the integrity of the scientific process.
The PHS 7065 form typically requires individuals to report information such as the name of the entity with which they have a financial interest, the nature of the interest, the value of the interest, and the duration of the interest. Additionally, individuals may be required to disclose any reimbursed or sponsored travel related to their research activities.
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