Definition of Potential Conflict of Interest Disclosure Form


Potential Conflict of Interest Disclosure Form means a written statement made, signed, and attested to by a covered individual that discloses all significant financial and other interests (and those of his/her spouse and dependent children) that to an independent observer would reasonably appear to be affected by research in which the individual is involved or that exist in entities whose financial interests to an independent observer would reasonably appear to be affected by the research (e.g., stock values, etc.). The Potential Conflict of Interest Disclosure Form (PCOI) must identify and describe, and state the nature and amount of the significant financial or other interest. The Potential Conflict of Interest Disclosure Form must be completed at the time of a grant application, or at the time of negotiation of a sponsored research agreement, or to disclose a significant change in a covered individual's (and those of his/her spouse or dependent children) financial and other interests. The Potential Conflict of Interest Disclosure Form is treated as confidential by the University and is considered part of the personnel file of the covered individual; however, the CCOI shall provide copies of such forms to university research panels or other institutional officials as appropriate. For covered 13 individuals with federally funded research, the contents PCOI form must be verified at least annually.
Sample 1 Sample 2

Examples of Potential Conflict of Interest Disclosure Form in a sentence

Covered individuals are required by the policy to notify the CCOI of any potential conflicts of interest through the Potential Conflict of Interest Disclosure Form.
The CCOI will determine what level of inquiry, if any, is necessary due to the content of the Potential Conflict of Interest Disclosure Form.
In addition, the Chief Compliance Officer is responsible for reviewing the "Potential Conflict of Interest Disclosure Form" and making a final determination for approval/disapproval of the disclosed conflict.