Financial Conflict of Interest Forms

Who discloses:

These forms must be filled out if you are now or will potentially be responsible for the design, conduct, or reporting of research activities at Boston University and/or Boston Medical Center. This includes, at minimum, all those listed as senior/key personnel on the grant application, where applicable. Please be advised that you may be requested to provide additional information based on the information disclosed.

When to disclose:

(1) no later than at the time of application for research (What is the Covered Research?);

(2) within 30 days of discovering or acquiring (e.g., through purchase, marriage, or inheritance) a new significant financial interest; and

(3) at least annually during the period of award. A targeted group of individuals in the research community will be asked to submit annual disclosures due to their participation in research in the past.

How to disclose:

You may disclose in one of two ways:

What to disclose:

For all BMC research and PHS-funded BU research, (or an organization following PHS FCOI rules), investigators are required to disclose financial interests (and those of the investigator’s spouse and dependent children) that reasonably appear to be related to the investigator’s institutional responsibilities, regardless of whether they are related to a specific research project or not. This includes outside remuneration, equity and royalties related to intellectual property.

For BU research not funded by PHS, investigators disclose only those financial interests that could be affected by the research.

Subaward  and Subcontract Forms

Subaward and Subcontract Forms

Letter of Intent to Enter into a Federal Subaward or Consortium Agreement

Where Boston Medical Center, as prime recipient, wishes to establish a subrecipient relationship with another institution as part of a research program, this form establishes which financial conflict of interest policy will apply—that of the prime institution or subrecipient institution.

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Addendum to NSF Letter of Intent

This form is attached to the subrecipient’s letter of intent for National Science Foundation (NSF)-funded research ONLY IF their letter does not address which institution’s COI policy rules apply. Otherwise, use the subrecipient’s letter of intent.

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Addendum to PHS Letter of Intent

This form is attached to the subrecipient’s letter of intent for Public Health Service (PHS)-funded research ONLY IF their letter does not address which institution’s COI policy rules apply. Otherwise, use the subrecipient’s letter of intent.

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Model FDP COI Policy (for Subrecipients)

If the subrecipient institution would like to adopt their own conflict of interest policy, the Federal Demonstration Partnership provides this one as a model.

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For NSF-funded awards to Boston Medical Center and Boston University, the Federal Demonstration Partnership provides this form (from Federal Demonstration Partnership for subawards).

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<”h3″ class="bu_collapsible">”NIH

For NIH-funded awards to Boston Medical Center and Boston University, the Federal Demonstration Partnership provides this form (from Federal Demonstration Partnership for subawards).

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Committee Members Resources

Independent Review – Optional Worksheet

Request for Information

Request for Information Form

This form is provided in accordance with the public accessibility requirement provided at 42 CFR 50.605(a)(5)(i)-(iv).

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