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This form is used by investigators at Boston University’s Medical Campus to disclose any significant financial interests that may be affected by their covered research activities.

How to fill out conflict of interest disclosure

How to fill out Conflict of Interest Disclosure Form (Comprehensive Form)

1. Begin by downloading the Conflict of Interest Disclosure Form (Comprehensive Form) from the official website.
2. Fill in your personal information, including your name, title, and department.
3. Read the instructions carefully before proceeding.
4. Identify any financial interests or relationships that could potentially create a conflict of interest.
5. Provide detailed descriptions of these interests, including the nature of the relationship and the entity involved.
6. Disclose any previous conflicts or situations that might relate to your current role.
7. Review the completed form to ensure accuracy and completeness.
8. Sign and date the form before submission.
9. Submit the completed form to the appropriate office or authority as directed.

Who needs Conflict of Interest Disclosure Form (Comprehensive Form)?

1. Individuals involved in decision-making positions within organizations.
2. Employees or board members who may have outside interests or relationships.
3. Consultants or contractors interacting with the organization.
4. Participants in research projects funded by grants.

People Also Ask about

What is the conflict of interest disclosure form?

Name of party/ individual with whom I may have a direct or indirect potential relationship: Details of my relationship with the party: Type of Conflict (select which apply): Relationship of the conflicted party with the Group: Any other details:

What is an example of a conflict of interest disclosure statement?

I confirm that neither I nor any of my relatives nor any business with which I am associated have any personal or business interest in or potential for personal gain from any of the organizations or projects linked to XYZ AIS.

What is a sample disclosure statement for conflict of interest?

Because of the perception of a conflict of interest and in the interest of full transparency, I am disclosing my relationship with [insert company name and/or nature of IP] to my research team members and collaborators.

What do you write in a conflict of interest statement?

A conflict of interest statement should include all sources of financial support (for example, sponsors, and grant numbers) other support for the study (such as collecting, analyzing, or interpreting data), writing or revising the manuscript, or any factor that limited (or will limit in the future) the investigators'

What is an example of a disclosure of interest?

Example 1: If you have shares in a company that has a matter before the meeting, you are closely associated with that company. You therefore have an interest that must be disclosed. You could disclose the nature of your interest as 'I am closely associated with the company making the application'.

What is a disclosure statement example?

A disclosure statement in such a case might read: “The author declares that (s)he has no relevant or material financial interests that relate to the research described in this paper”.

For pdfFiller’s FAQs

What is Conflict of Interest Disclosure Form (Comprehensive Form)?

The Conflict of Interest Disclosure Form (Comprehensive Form) is a document used to identify and disclose potential conflicts of interest that may affect an individual's ability to act impartially in their professional duties.

Who is required to file Conflict of Interest Disclosure Form (Comprehensive Form)?

Individuals in positions of authority or those who have decision-making power within an organization, such as employees, board members, and contractors, are generally required to file the Conflict of Interest Disclosure Form (Comprehensive Form).

How to fill out Conflict of Interest Disclosure Form (Comprehensive Form)?

To fill out the Conflict of Interest Disclosure Form (Comprehensive Form), individuals must provide personal information, details about their relationships and affiliations that may give rise to conflicts of interest, and any financial interests that could impact their professional responsibilities.

What is the purpose of Conflict of Interest Disclosure Form (Comprehensive Form)?

The purpose of the Conflict of Interest Disclosure Form (Comprehensive Form) is to ensure transparency and integrity in decision-making processes by allowing organizations to identify and manage potential conflicts that could influence actions or judgments.

What information must be reported on Conflict of Interest Disclosure Form (Comprehensive Form)?

The information that must be reported includes the individual's name, position, any relevant relationships (e.g., family connections), financial interests (e.g., investments), and other affiliations or engagements that could create a conflict with their duties.