Get the free Significant Financial Interest Disclosure Form - niu

This form is used by faculty, staff, and students of Northern Illinois University to disclose any significant financial interests that could potentially affect their research or institutional responsibilities.

How to fill out significant financial interest disclosure

How to fill out Significant Financial Interest Disclosure Form

1. Obtain the Significant Financial Interest Disclosure Form from your institution or organization.
2. Read the instructions carefully to understand the requirements.
3. Fill in your personal information, including your name, position, and department.
4. List all significant financial interests related to your research or professional activities.
5. Specify the nature of each financial interest, including the amount and the entity involved.
6. Disclose any financial interests that could create a conflict of interest.
7. Review the form for accuracy and completeness.
8. Sign and date the form to certify the information provided is true and complete.
9. Submit the form to the appropriate office or department as directed.

Who needs Significant Financial Interest Disclosure Form?

1. Researchers and faculty members who receive funding from public or private sources.
2. Individuals participating in research studies or clinical trials.
3. Anyone involved in decision-making processes that could affect financial interests.

People Also Ask about

What is an example of a no conflict of interest disclosure statement?

Example: I declare that I have no conflicts of interest related to this research/study/project. I have no personal or financial relationships that could influence my work.

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'.

How do you write a disclosure of interest?

Generally speaking, disclosure statements should identify the following: The individual with the financial interest; The financial interest and/or entity creating the actual or potential conflict; and. The relationship between the financial interest and the research being presented.

What is the full form of FCOI?

Financial Conflict of Interest (fCOI) Statements.

What is an example of a disclosure statement?

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”.

What is an example of a coi 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 significant financial interest disclosure?

Disclosure of significant financial interests means an Investigator's disclosure of significant financial interests to an Institution. Financial conflict of interest (FCOI) means a significant financial interest that could directly and significantly affect the design, conduct, or reporting of PHS-funded research.

For pdfFiller’s FAQs

What is Significant Financial Interest Disclosure Form?

The Significant Financial Interest Disclosure Form is a document used to disclose any financial interests that could potentially influence or appear to influence an individual's research, professional activities, or decision-making.

Who is required to file Significant Financial Interest Disclosure Form?

Individuals who are involved in research activities, including faculty, staff, and students, are typically required to file the Significant Financial Interest Disclosure Form to ensure transparency and compliance with institutional and federal regulations.

How to fill out Significant Financial Interest Disclosure Form?

To fill out the Significant Financial Interest Disclosure Form, individuals should provide accurate information about their financial interests, including types of income, equity interests, and affiliations with outside entities, and submit the completed form to the appropriate institutional office.

What is the purpose of Significant Financial Interest Disclosure Form?

The purpose of the Significant Financial Interest Disclosure Form is to identify and manage potential conflicts of interest that may arise from financial relationships, ensuring the integrity of research and professional conduct.

What information must be reported on Significant Financial Interest Disclosure Form?

The form generally requires information such as the nature of the financial interest, amount of income received, ownership interests, stock holdings, and any consulting fees from outside entities related to the individual's work.