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?

 

PLEASE CLICK ON THE LINKS BELOW TO ACCESS THE 

APPROPRIATE DISCLOSURE FORMS. 

These forms can be filled out electronically or printed and completed manually.  The saved document should be submitted with your other research proposal documents to the Office of Science & Research (e.g. IRB, IACUC or SPA).  

PDF Version 

Investigator Financial Interest Disclosure Form 

 

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 DISCLOSURE FORM.

Supplemental Disclosure Form (Word Version)

Supplemental Disclosure Form (PDF Version)

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.