Last Name
* must provide value
First Name
* must provide value
OUHSC Username
* must provide value
Username for logging into OUHSC systems and programs. (e.g. jsmith1)
Job Title
* must provide value
Department
* must provide value
Do you conduct, oversee, or participate in any research at the University?
* must provide value
No Yes
INSTRUCTIONS: Mark your answer for EACH question below as it relates to you or a member of your family.
SAVE AND RETURN LATER: If you need to leave the form, click the 'Save and Return Later' button available at the bottom of each page to exit the disclosure form. Your work will be saved and you will receive a code via e-mail to return to your draft. Do not begin a new form.
OU Health: Dual employment at OU Health is not considered to be employment outside of the University. Any non-OU, domestic or foreign, public or private, organization (excluding a US Federal agency) from which you and/or your family member receive remuneration or have an ownership or equity interest.
Equity: Any stock, stock option, or other ownership interest, whether or not the value can be determined through reference to public prices or other reasonable measures of fair market value.
Family: a spouse/domestic partner, parent, child, stepchild, or sibling of an Employee or a member of your (the Employee's) household.
Remuneration: Any payment received from an outside entity in any form, including but not limited to: stocks, bonds, stock options, warrants, partnership interests, rights to patent or royalty payments, consulting fees, honoraria, speaking fees, salary, loans, lectureship fees, or fees for serving on boards of directors, scientific and other advisory boards.
Significant Financial Interest (SFI): Anything of monetary value that meets any of the following criteria (when combined for you, your spouse, and/or your dependent children):
Income >$5,000 in the past 12 months As of the date of disclosure, any combination of income + equity in a publicly traded company >$5,000. Any equity interest in a non-publicly traded company Third party reimbursed or sponsored travel >$5,000 for any reportable travel related to your organizational responsibilities for OU Income >$5,000 for intellectual property not owned by OU
This disclosure is:
* must provide value
Which disclosed activity are you updating?
(Provide the name of the company, activity, or family member so that we may connect this form with your previous disclosure)
* must provide value
Which previously disclosed activity or relationship has been terminated (or ended)?
Provide the name of the company, activity, or family member associated with the terminated activity.
* must provide value
1. Business Relationships / Business Ownership and Equity
Do you or your family member(s) have any business relationships with an entity that does business with OU or is attempting to do with business with OU?
AND/OR
Do you or your family member(s) own, or have any equity in any businesses that does business with OU or is attempting to do business with OU?
IMPORTANT: Investment vehicles, such as mutual funds and retirement accounts, where the Member does not directly control the investment decisions is not an interest that should be disclosed as per the Regents' Individual COI Policy.
* must provide value
No
Yes
2. Intellectual Property, Patents, RoyaltiesDo you or your family member(s) have any income from intellectual property (e.g., patents, patent applications, license agreements, or copyrights)?
* must provide value
No
Yes
3. Multiple Relationships with an Entity
Do you have more than one contract with a single external entity, either through the University or as an individual?
Example: Consulting or serving on an advisory board for a company while also conducting a clinical trial for the same company is one example of having more than one contract - or multiple relationships - with a single entity.
* must provide value
No
Yes
4. Outside Jobs and/or ActivitiesDo you or your family member have additional job(s) or are you/your family member involved in any activities, whether at OU or outside of OU (including paid or unpaid external adjunct appointments and/or titles)?
* must provide value
No
Yes
*This excludes religious and social activities
5. Nepotism
Do you have a family member who works on any campus at OU?
* must provide value
No
Yes
6. Gifts
Have you (as an individual or on behalf of your department) or your family member(s) accepted gratuities, gifts, or special favors from either a person or an entity who is doing business with (or proposing to do business with) the University?
A gift includes but is not limited to: food, tickets, trip expenses, cash, and/or gift cards.
* must provide value
No
Yes
7. International Activities
Do you or your family member(s) have any international collaborations or appointments, paid or unpaid?
* must provide value
No
Yes
8. Travel
Have you or your family member traveled within the past 12 months - or do you have upcoming travel plans - that will be reimbursed directly to you, to the University, or arranged or paid for on your behalf by an external business, entity, or person?
Travel expenses include but are not limited to: transportation, accommodations, meals, and leisure activities.
* must provide value
No
Yes
1.1.1: Name of Business Entity:
1.1.2: Who is affiliated with this business entity?
Myself Family Member Both
1.1.3: What is the business entity's relationship with OU? (Select all that apply)
Supplier of goods and/or services
Consultant or advisory board
Research activities
Business or clinical referrals
Licensing agreement
Ownership
Equity in company
Provides funds and/or gifts to your unit (department, clinic, office, college) in support of education, travel, research, or other activities
Other contractual or business relationship
Supplier of goods and/or services
Consultant or advisory board
Research activities
Business or clinical referrals
Licensing agreement
Ownership
Equity in company
Provides funds and/or gifts to your unit (department, clinic, office, college) in support of education, travel, research, or other activities
Other contractual or business relationship
1.1.4: Which options below pertain to you or your family member's relationship with the entity? (Select all that apply)
My activity is related to my OU responsibilities.
I receive compensation outside of my OU salary (e.g. royalties, equity, salary).
I am in a position to influence contracts and agreements made between OU and the entity.
I have used, will use, or may use OU's name, resources, or confidential information in connection with this entity.
None of the above.
My activity is related to my OU responsibilities.
I receive compensation outside of my OU salary (e.g. royalties, equity, salary).
I am in a position to influence contracts and agreements made between OU and the entity.
I have used, will use, or may use OU's name, resources, or confidential information in connection with this entity.
None of the above.
1.1.5: Provide additional information to describe and explain all selections made in the previous question .
For example : how is the outside activity related to your OU responsibilities?
For example : if you have received compensation outside of your OU salary, was compensation paid directly to you or was it paid to the University through a contract between the entity and OU?
For example : if you have received compensation outside of your OU salary, what activity or scope of work did you receive compensation for? (talk/presentation sponsored by the entity; consulting; advisory board; listening to sales or promotional/marketing talks; attending a CME session; etc.)
1.1.6: This business/entity is a:
Publicly traded entity or foreign government Non-publicly traded entity
1.1.7: Select the total value of your relationship with the business/entity, including income and equity holdings:
$0-$4,999 $5,000-$9,999 $10,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
1.1.8: Additional Information About Financial Value/Compensation & Relationship to Entity:
Add Another Record / Add Another Business?
Yes
No
1.2.1: Name of Business Entity:
1.2.2: Who is affiliated with this business entity?
Myself Family Member Both
1.2.3: What is the business entity's relationship with OU? (Select all that apply)
Supplier of goods and/or services
Consultant or advisory board
Research activities
Business or clinical referrals
Licensing agreement
Ownership
Equity in company
Provides funds and/or gifts to your unit (department, clinic, office, college) in support of education, travel, research, or other activities
Other contractual or business relationship
Supplier of goods and/or services
Consultant or advisory board
Research activities
Business or clinical referrals
Licensing agreement
Ownership
Equity in company
Provides funds and/or gifts to your unit (department, clinic, office, college) in support of education, travel, research, or other activities
Other contractual or business relationship
1.2.4: What is the business entity's relationship with OU? (Select all that apply)
My activity is related to my OU responsibilities.
I receive compensation outside of my OU salary (e.g. royalties, equity, salary).
I am in a position to influence contracts and agreements made between OU and the entity.
I have used, will use, or may use OU's name, resources, or confidential information in connection with this entity.
None of the above.
My activity is related to my OU responsibilities.
I receive compensation outside of my OU salary (e.g. royalties, equity, salary).
I am in a position to influence contracts and agreements made between OU and the entity.
I have used, will use, or may use OU's name, resources, or confidential information in connection with this entity.
None of the above.
1.2.5: Provide additional information to describe and explain all selections made in the previous question .
For example : How is the outside activity related to your OU responsibilities?
For example : If you have received compensation outside of your OU salary, was compensation paid directly to you or was it paid to the University through a contract between the entity and OU?
For example : If you have received compensation outside of your OU salary, what activity or scope of work did you receive compensation for? (talk/presentation sponsored by the entity; consulting; advisory board; listening to sales or promotional/marketing talks; attending a CME session; etc.)
1.2.6: This business/entity is a:
Publicly traded entity or foreign government Non-publicly traded entity
1.2.7: Select the total value of your relationship with the business/entity, including income and equity holdings:
$0-$4,999 $5,000-$9,999 $10,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
1.2.8: Additional Information About Financial Value/Compensation & Relationship to Entity:
Add Another Record / Add Another Business?
Yes
No
1.3.1: Name of Business Entity:
1.3.2: Who is affiliated with this business entity?
Myself Family Member Both
1.3.3: What is the business entity's relationship with OU? (Select all that apply)
Supplier of goods and/or services
Consultant or advisory board
Research activities
Business or clinical referrals
Licensing agreement
Ownership
Equity in company
Provides funds and/or gifts to your unit (department, clinic, office, college) in support of education, travel, research, or other activities
Other contractual or business relationship
Supplier of goods and/or services
Consultant or advisory board
Research activities
Business or clinical referrals
Licensing agreement
Ownership
Equity in company
Provides funds and/or gifts to your unit (department, clinic, office, college) in support of education, travel, research, or other activities
Other contractual or business relationship
1.3.4: What is the business entity's relationship with OU? (Select all that apply)
My activity is related to my OU responsibilities.
I receive compensation outside of my OU salary (e.g. royalties, equity, salary).
I am in a position to influence contracts and agreements made between OU and the entity.
I have used, will use, or may use OU's name, resources, or confidential information in connection with this entity.
None of the above.
My activity is related to my OU responsibilities.
I receive compensation outside of my OU salary (e.g. royalties, equity, salary).
I am in a position to influence contracts and agreements made between OU and the entity.
I have used, will use, or may use OU's name, resources, or confidential information in connection with this entity.
None of the above.
1.3.5: Provide additional information to describe and explain all selections made in the previous question .
For example : How is the outside activity related to your OU responsibilities?
For example : If you have received compensation outside of your OU salary, was compensation paid directly to you or was it paid to the University through a contract between the entity and OU?
For example : If you have received compensation outside of your OU salary, what activity or scope of work did you receive compensation for? (talk/presentation sponsored by the entity; consulting; advisory board; listening to sales or promotional/marketing talks; attending a CME session; etc.)
1.3.6: This business/entity is a:
Publicly traded entity or foreign government Non-publicly traded entity
1.3.7: Select the total value of your relationship with the business/entity, including income and equity holdings:
$0-$4,999 $5,000-$9,999 $10,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
1.3.8: Additional Information About Financial Value/Compensation & Relationship to Entity:
2.1: Name of Invention / Product / Article / Copyrighted Material
2.2: Was the invention / product / article / copyrighted material generated as a result of or related to your work at OU?
No
Yes
2.3: Are you receiving any compensation or benefits outside of your OU salary for this invention / product / article / copyrighted material (e.g., salary, royalties, equity)?
* must provide value
No
Yes
3.1: Name of Entity with whom you have multiple relationships through or outside OU:
3.2: How many different types
Note : the number you select may not match the total number of contracts/agreements in place with this entity.
For example : an employee could have 2-3 active clinical trial agreements in place. 'Clinical trial agreement' would count as 1 type of contract/agreement.
For example : an employee with a consulting professional service agreement and a clinical trial agreement would select '2' from the drop-down menu as these are 2 different types of contracts/agreements.
2 3 4
3.3: Type of contract with the entity (e.g. advisory, consulting, speaking, clinical trial, etc.):
3.4: Select the dollar value of the contract:
$0-$4,999 $5,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
3.5: Briefly describe the activity (scope of work) for this contract:
3.6: Type of contract with the entity (e.g. advisory, consulting, speaking, clinical trial, etc.):
3.7: Select the dollar value of the contract:
$0-$4,999 $5,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
3.8: Briefly describe the activity (scope of work) for this contract:
3.9: Type of contract with the entity (e.g. advisory, consulting, speaking, clinical trial, etc.):
3.10: Select the dollar value of the contract:
$0-$4,999 $5,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
3.11: Briefly describe the activity (scope of work) for this contract:
3.12: Type of contract with the entity (e.g. advisory, consulting, speaking, clinical trial, etc.):
3.13: Select the dollar value of the contract:
$0-$4,999 $5,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
3.14: Briefly describe the activity (scope of work) for this contract:
Add another business/entity?
No
Yes
3.15: Name of Entity with whom you have multiple relationships through or outside OU:
3.16: How many different types
Note : the number you select may not match the total number of contracts/agreements in place with this entity.
For example : an employee could have 2-3 active clinical trial agreements in place. 'Clinical trial agreement' would count as 1 type of contract/agreement.
For example : an employee with a consulting professional service agreement and a clinical trial agreement would select '2' from the drop-down menu as these are 2 different types of contracts/agreements.
2 3 4
3.17: Type of contract with the entity (e.g. advisory, consulting, speaking, clinical trial, etc.):
3.18: Select the dollar value of the contract:
$0-$4,999 $5,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
3.19: Briefly describe the activity (scope of work) for this contract:
3.20: Type of contract with the entity (e.g. advisory, consulting, speaking, clinical trial, etc.):
3.21: Select the dollar value of the contract:
$0-$4,999 $5,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
3.22: Briefly describe the activity (scope of work) for this contract:
3.23: Type of contract with the entity (e.g. advisory, consulting, speaking, clinical trial, etc.):
3.24: Select the dollar value of the contract:
$0-$4,999 $5,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
3.25: Briefly describe the activity (scope of work) for this contract:
3.26: Type of contract with the entity (e.g. advisory, consulting, speaking, clinical trial, etc.):
3.27: Select the dollar value of the contract:
$0-$4,999 $5,000-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and over
3.28: Briefly describe the activity (scope of work) for this contract:
4.1: Name of outside entity/organization tied to this activity/employment:
4.2: Do you have an external appointment or title at this outside entity/ organization (paid or unpaid) that is in addition to your position at the University of Oklahoma?
No
Yes
4.3: Describe your outside job, activity(ies), or relationship(s):
What are your roles/responsibilities? Are they related to your responsibilities at OU?
For external appointments or titles, include date of appointment(s) and titles.
4.4: Describe the time commitment or schedule for this outside activity/employment: Does the activity take place during or outside OU business hours? Do you take paid time off (PTO) if the activity takes place during OU business hours? How many hours per week or month is spent on this activity or employment?
4.5: Do you have approval from your supervisor for this outside employment or activity?
* must provide value
No
Yes
4.6: Have you used, or will you use OU's name, resources, or confidential information in connection with the outside activity?
Resources include OU facilities, personnel, supplies, time, and/or equipment.
No
Yes
4.7: If 'Yes' to 4.6, please describe and explain:
Type "N/A" if 4.6 is 'No'
Add Another Outside Activity or Outside Employment?
No
Yes
4.8: Name of outside entity/organization tied to this activity/employment:
4.9: Do you have an external appointment or title at this outside entity/ organization (paid or unpaid) that is in addition to your position at the University of Oklahoma?
No
Yes
4.10: Describe your outside job, activity(ies), or relationship(s):
What are your roles/responsibilities? Are they related to your responsibilities at OU?
For external appointments or titles, include date of appointment(s) and titles.
4.11: Describe the time commitment or schedule for this outside activity/employment: Does the activity take place during or outside OU business hours? Do you take paid time off (PTO) if the activity takes place during OU business hours? How many hours per week or month is spent on this activity or employment?
4.12: Do you have approval from your supervisor for this outside employment or activity?
* must provide value
No
Yes
4.13: Have you used, or will you use OU's name, resources, or confidential information in connection with the outside activity?
Resources include OU facilities, personnel, supplies, time, and/or equipment.
No
Yes
4.14: If 'Yes' to 4.13, please describe and explain:
* must provide value
Type "N/A" if 4.13 is 'No'
Add Another Outside Activity or Outside Employment?
No
Yes
4.15: Name of outside entity/organization tied to this activity/employment:
4.16: Do you have an external appointment or title at this outside entity/ organization (paid or unpaid) that is in addition to your position at the University of Oklahoma?
No
Yes
4.17: Describe your outside job, activity(ies), or relationship(s):
What are your roles/responsibilities? Are they related to your responsibilities at OU?
For external appointments or titles, include date of appointment(s) and titles.
4.18: Describe the time commitment or schedule for this outside activity/employment: Does the activity take place during or outside OU business hours? Do you take paid time off (PTO) if the activity takes place during OU business hours? How many hours per week or month is spent on this activity or employment?
4.19: Do you have approval from your supervisor for this outside employment or activity?
* must provide value
No
Yes
4.20: Have you used, or will you use OU's name, resources, or confidential information in connection with the outside activity?
Resources include OU facilities, personnel, supplies, time, and/or equipment.
No
Yes
4.21: If 'Yes' to 4.20, please describe and explain:
* must provide value
Type "N/A" if 4.20 is 'No'
The Board of Regents Individual COI Policy defines family
5.1: Select the number of family members employed
1 2 3 4
Family Member 1
5.3: Relationship to you:
Spouse Domestic Partner Parent Child Stepchild Sibling Member of my household
5.4: A working relationship means that you have or will have University business-related contact with your family member. Please select all that apply:
Family member works on/for the Norman Campus (either in Norman, Tulsa, or other location)
Family member works on/for OUHSC (either in OKC, Tulsa, or other location)
We collaborate on sponsored projects together (research, training, public service, grants, or contracts)
Work in the same department as the family member
Directly or indirectly supervise this family member
Directly or indirectly responsible for the family member's performance review
Directly or indirectly determine compensation for this family member
Directly or indirectly assign work to this family member who also works at OU
Work in different departments and have no business-related contact or interactions
Family member works on/for the Norman Campus (either in Norman, Tulsa, or other location)
Family member works on/for OUHSC (either in OKC, Tulsa, or other location)
We collaborate on sponsored projects together (research, training, public service, grants, or contracts)
Work in the same department as the family member
Directly or indirectly supervise this family member
Directly or indirectly responsible for the family member's performance review
Directly or indirectly determine compensation for this family member
Directly or indirectly assign work to this family member who also works at OU
Work in different departments and have no business-related contact or interactions
Family Member 2
5.6: Relationship to you:
Spouse Domestic Partner Parent Child Stepchild Sibling Member of my household
5.7: A working relationship means that you have or will have University business-related contact with your family member. Please select all that apply:
Family member works on/for the Norman Campus (either in Norman, Tulsa, or other location)
Family member works on/for OUHSC (either in OKC, Tulsa, or other location)
We collaborate on sponsored projects together (research, training, public service, grants, or contracts)
Work in the same department as the family member
Directly or indirectly supervise this family member
Directly or indirectly responsible for the family member's performance review
Directly or indirectly determine compensation for this family member
Directly or indirectly assign work to this family member who also works at OU
Work in different departments and have no business-related contact or interactions
Family member works on/for the Norman Campus (either in Norman, Tulsa, or other location)
Family member works on/for OUHSC (either in OKC, Tulsa, or other location)
We collaborate on sponsored projects together (research, training, public service, grants, or contracts)
Work in the same department as the family member
Directly or indirectly supervise this family member
Directly or indirectly responsible for the family member's performance review
Directly or indirectly determine compensation for this family member
Directly or indirectly assign work to this family member who also works at OU
Work in different departments and have no business-related contact or interactions
Family Member 3
5.9: Relationship to you:
Spouse Domestic Partner Parent Child Stepchild Sibling Member of my household
5.10: A working relationship means that you have or will have University business-related contact with your family member. Please select all that apply:
Family member works on/for the Norman Campus (either in Norman, Tulsa, or other location)
Family member works on/for OUHSC (either in OKC, Tulsa, or other location)
We collaborate on sponsored projects together (research, training, public service, grants, or contracts)
Work in the same department as the family member
Directly or indirectly supervise this family member
Directly or indirectly responsible for the family member's performance review
Directly or indirectly determine compensation for this family member
Directly or indirectly assign work to this family member who also works at OU
Work in different departments and have no business-related contact or interactions
Family member works on/for the Norman Campus (either in Norman, Tulsa, or other location)
Family member works on/for OUHSC (either in OKC, Tulsa, or other location)
We collaborate on sponsored projects together (research, training, public service, grants, or contracts)
Work in the same department as the family member
Directly or indirectly supervise this family member
Directly or indirectly responsible for the family member's performance review
Directly or indirectly determine compensation for this family member
Directly or indirectly assign work to this family member who also works at OU
Work in different departments and have no business-related contact or interactions
Family Member 4
5.12 Relationship to you:
Spouse Domestic Partner Parent Child Stepchild Sibling Member of my household
5.13: A working relationship means that you have or will have University business-related contact with your family member. Please select all that apply:
Family member works on/for the Norman Campus (either in Norman, Tulsa, or other location)
Family member works on/for OUHSC (either in OKC, Tulsa, or other location)
We collaborate on sponsored projects together (research, training, public service, grants, or contracts)
Work in the same department as the family member
Directly or indirectly supervise this family member
Directly or indirectly responsible for the family member's performance review
Directly or indirectly determine compensation for this family member
Directly or indirectly assign work to this family member who also works at OU
Work in different departments and have no business-related contact or interactions
Family member works on/for the Norman Campus (either in Norman, Tulsa, or other location)
Family member works on/for OUHSC (either in OKC, Tulsa, or other location)
We collaborate on sponsored projects together (research, training, public service, grants, or contracts)
Work in the same department as the family member
Directly or indirectly supervise this family member
Directly or indirectly responsible for the family member's performance review
Directly or indirectly determine compensation for this family member
Directly or indirectly assign work to this family member who also works at OU
Work in different departments and have no business-related contact or interactions
6.1: Describe the form and frequency of the gift, gratuity, or favor received by you or your family member: (E.g. if meals were received, include the number of meals within the past year from this same source)
6.2: Name of the source of the gift (e.g. company, vendor):
6.3: Total dollar value of the gift(s), gratuity, or favor:
6.4 What is your role at OU in purchasing and vendor requests for this entity who provided the gift(s)? (Select all that apply)
7.1: Name of International Entity / Organization:
7.2: Location of International Entity:
7.3: Name of contacts and collaborators at the International Entity:
7.4: Do you conduct research in collaboration with or provide other services to this International Entity?
No
Yes
7.4a: Is there an OU approved contract between OU and this International Entity for the research, services, or activities?
No
Yes
7.5: Describe your outside professional activities (scope of work) and financial relationship, whether compensated or uncompensated:
8.1: Name of Business, Entity, or Person paying for travel:
8.3: Travel Destination / Location:
8.5: Value of travel (if unknown, provide an estimate):
8.6: What services will be paid for by the Business, Entity, or Person (example: airfare, lodging, meals, etc.)?
8.7: Select all that apply:
Do you have an approved COI Management Plan (or approved Nepotism Waiver) in place for the disclosed relationship(s) or activity/activities?
* must provide value
No
Yes
Upload your COI Management Plan.
If you have multiple documents or plans to submit, please combine documents and upload them all together as one (1) file.
IMPORTANT: This is a required question. You cannot proceed until you upload the management plan. If you need to leave the form for now, click the 'Save and Return Later' button to exit the form and save your work. You will receive a code via email so you can return to this draft form. Do not create a new form to start over.
* must provide value
BOARD OF REGENTS INDIVIDUAL COI POLICY (The header is a clickable link that will take you to the COI website. You can access and review the policy on the right side under "Links and Resources".)
* must provide value
CERTIFICATION OF TRAINING (for Research)
I hereby certify that I have either:
* must provide value
No research funding source that follows conflict of interest regulations promulgated by the Public Health Service at 42 CFR 50.606; OR
No research funding source that follows conflict of interest regulations promulgated by the Public Health Service at 42 CFR 50.606; OR
Completed the required training for PHS investigators at the following link: FCOI PHS Training
COMPLIANCE REPORTING OPTIONS
I understand that if I have compliance related concerns, questions, violations, or issues to report, I can report these using any of the options below:
* must provide value
DECLARATION OF DISCLOSURE
* must provide value
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