Investigator Financial Interest Disclosure Form


Who Needs to Complete the Investigator Financial Interest Disclosure Form?

All Investigators must submit an Investigator Financial Interest Disclosure Form (see guidance below on supplemental disclosure requirements). Please note that this includes sub-recipients of grants and contracts.


 

Where Can I Find the Disclosure Form?

 

*NEW INVESTIGATOR FINANCIAL INTEREST DISCLOSURE FORM, effective August 24, 2012!

 

 UPDATES to the DISCLOSURE FORM include...

Annual Disclosure Certification;

Disclosure of Paid and Reimbursed Travel; and

New Fillable PDF Form for Easier Completion.

 

PLEASE CLICK ON THE LINKS BELOW TO ACCESS THE NEW DISCLOSURE FORM.   Both forms can be saved, printed and emailed electronically as needed.

NEW! Adobe PDF Version - Fillable Form*

Investigator Financial Interest Disclosure Form 

(Please allow time for form to open, may take longer due to document type)

Microsoft Word Version

Investigator Financial interest Disclosure Form 

 *If you are unable to use the fillable form as intended, it is because you do not have the proper version of Adobe installed on your sytem.  You may use the Word version of the document provided below or submit a ticket to IT or call them at 263-6868 to install the Adobe Acrobat X Professional on your computer.


How Do I Know if I Need to Submit a Supplemental Disclosure Form?

Stop Sign

DID YOU ANSWER "YES" TO ANY OF THE QUESTIONS

ON YOUR DISCLOSURE FORM?

If you answered "Yes" to any of the questions on your Investigator Financial Interest Disclosure Form, You Must Complete the SUPPLEMENTAL Investigator Financial Interest Disclosure Form.

*NEW PROCESS FOR SUBMITTING SUPPLEMENTAL DISCLOSURE, effective 8/24/12:   

Please submit your Supplemental Disclosure Form along with your Investigator Financial Interest Disclosure Form and other research proposal documents to the Office of Science &  Research (e.g. IRB, IACUC or SPA). 

*DO NOT SUBMIT YOUR DISCLOSURE FORMS TO THE CIMU DIRECTLY, unless otherwise requested.  

    CONFIDENTIALITY. All disclosures will be kept confidential and disclosed only on a need-to-know basis as required to perform the review and evaluation required by this Policy and the Medical Center's Policies on Conflicts of Interest, Commitment and Consulting


When Should You Submit Your Investigator Financial Interest Disclosure Form

 

  1. Upon submission of each proposal of a Sponsored Project to the IRB, IACUC or Sponsored Research Office, even if the Investigator does not have a Financial Interest to disclose;
  2. At each annual continuation of the Sponsored Project thereafter; and
  3. Prior to obtaining any new Financial Interest during an ongoing Sponsored Project.