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DISCLOSING SIGNIFICANT FINANCIAL INTERESTS FOR UNC INVESTIGATORS (University of Northern Colorado)

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DISCLOSING SIGNIFICANT FINANCIAL INTERESTS
FOR UNC INVESTIGATORS
The University of Northern Colorado’s Financial Conflict of Interest Policy is found in the University Regulations Article 3,
Part 4, Section 3-3-402(1), and the implementing procedures are found at http://www.unco.edu/osp/policies/fcoiproc.pdf.
Please review those documents and read the following before completing the disclosure form.
Disclosure Requirements: As an investigator on an externally funded project or a proposal for external funding, you are
required disclose your significant financial interests (SFI), aggregated with those of your spouse and dependent children,
on the attached disclosure form.
o The Office of Sponsored Programs (OSP) must have disclosures prior to submitting your proposal for external
funding.
o You are also required to submit a disclosure update during the period of any award funded by PHS or NSF (whether
direct or pass through funding) within 30 days of discovering or acquiring any new financial interest (including
those that may arise between the time the proposal is submitted and the time an award is made).
o You are also required to submit annual update disclosures during the period of any PHS funded award. These
annual updates are due between November 1 and November 30 regardless of when you made your initial
disclosure or disclosed new SFIs.
NOTE: UNC will not submit a proposal until all investigators (including any subrecipient investigators, if applicable) have
submitted disclosures to the Office of Sponsored Programs. The PI is responsible for ensuring that all other Investigators
submit their disclosures.
Training Requirement on PHS funded projects: Investigators on PHS funded awards are required to complete conflict of
interest training before engaging in work related to the PHS funded award, and again every four years during any PHS
funded award. The required training is available on-line through the Collaborative Institutional Training Initiative (CITI).
To access CITI, follow the directions at: http://www.unco.edu/osp/ethics/citi.html; and on the CITI website, complete the
Financial Conflict of Interest modules. You will need to affiliate your training with the University of Northern Colorado so
that we receive notification from CITI when you have completed the training.
DISCLOSURE DEFINITIONS
o Remuneration includes all salary and any payment for services not otherwise identified as salary, such as
consulting fees, honoraria, and paid authorships.
o Equity interest includes any stock, stock option, or other ownership interest with the value determined through
public prices or other reasonable measures of fair market value.
DISCLOSURE EXCEPTIONS – DO NOT INCLUDE the following when disclosing financial interests:
o Salary, royalties, or other remuneration paid by UNC if you (or your spouse or dependent children, as applicable)
are currently employed or otherwise appointed by UNC;
o Income related to intellectual property rights assigned to UNC or to agreements to share in royalties related to
such rights;
o Income from investment vehicles such as mutual funds and retirement accounts for which you, your spouse and
dependent children do not directly control the investment decisions made in such vehicles
o Income from seminars, lectures, or teaching engagements sponsored by a Federal, state, or local government
agency, an institution of higher education as defined at 20 U.S.C. 1001(a), an academic teaching hospital, a
medical center, or a research institute that is affiliated with an institution of higher education as defined at 20
U.S.C. 1001(a)
o Income from service on advisory committees or review panels for a Federal, state, or local government agency,
an institution of higher education as defined at 20 U.S.C. 1001(a), an academic teaching hospital, a medical
center, or a research institute that is affiliated with an institution of higher education as defined at 20 U.S.C.
1001(a)
You need to report only those Significant Financial Interests that are directly related to your responsibilities as an employee of the
University of Northern Colorado.
Please address questions regarding FCOI disclosures to Nicole Morse at 970-351-1910 or nicole.morse@unco.edu.
05.2016
D
ISCLOSURE DETAILS
When you complete the disclosure form (last page of this document), if you check to indicate that you are disclosing any
changes to your significant financial interests, as listed in numbers 1 through 6, attach additional pages to your disclosure
to provide details as listed below:
When responding, remember that, as the investigator, you are to disclose financial interests that are aggregated for
yourself, your spouse, and your dependent children.
1. If you check #1 on the disclosure form, provide the following for each publicly traded entity involved:
o The name of the publicly traded entity
o The combined value of remuneration received and equity interest
o An explanation of how you determined the value of your equity interest
o An explanation of how this financial interest could or could not appear to be related to your research and othe
r
e
ducational activities that are conducted as part of your institutional responsibilities
2. If you check #2 on the disclosure form, provide the following for each non-publicly traded entity involved:
o The name of the non-publicly traded entity
o Whether the financial interest was remuneration or equity interest
o If it was remuneration, the value of that received
o An explanation of how you determined the value of your equity interest
o An explanation of how this financial interest could or could not appear to be related to your research and othe
r
e
ducational activities that are conducted as part of your institutional responsibilities
3. If you check #3 on the disclosure form, provide a list of the intellectual property (copyrights, patents, etc.) and the
value of income received from each
4. If you check #4 on the disclosure form, provide the following for each entity involved:
o The name of the entity
o The value of the equity interes
t
o T
he percentage of ownership your interest represents in that entity
o An explanation of how you determined the value of the equity interest
o An explanation of how this financial interest could or could not appear to be related to your research and othe
r
educational activities that are conducted as part of your institutional responsibilities
5. If you check #5 on the disclosure form, provide the following for each instance of such travel:
o The purpose of the travel
o The entity that paid for the travel
o The destination(s)
o The dates of the travel
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Please do not submit these guidelines with your disclosure form.
It
is only the form on the next page that should be submitted to the Office of Sponsored Programs.
SUBMITTING DISCLOSURES:
The signed, completed form for any FCOI disclosure is to be submitted to:
Office of Sponsored Programs
Campus Box #143
Attention: 'ƌĂŶƚĂŶĚŽŶƚƌĂĐƚĚŵŝŶŝƐƚƌĂƚŽƌ
Or a scanned copy may be emailed to
All disclosures, must have manual or digital signatures; a typed name will not be accepted.
S
ave a copy of your disclosures for your project files.
05.2016
your Grant and Contract Administrator
University of Northern Colorado
Disclosure of Significant Financial Interests
UNC Investigator
Name: Bear # (last 4): Unit:
Name of PI/PD (if not you): Your role on project:
Sponsor:
If this project is a subaward to UNC, the funding originates from: NSF Unit of PHS Other Sponsor
Title of Project:
Check one: Initial disclosure Update disclosing new significant financial interests Required annual update
Check all of the following that represent your significant financial interests when aggregated with those of your
spouse and dependent children.
1. Remuneration received from any publicly traded entity during the 12 months preceding this disclosure,
plus any equity interest in that entity as of the date of this disclosure, the combined value of which
exceeds $5,000.
2. Remuneration received during the 12 months preceding this disclosure from any non-publicly traded
entity that exceeds $5,000 in value, or any equity interest in that entity as of the date of this disclosure
3. Income related to intellectual property rights and interests.
4. Equity interest in any single entity, the value of which exceeds $10,000 and represents more than a 5%
ownership as of the date of this disclosure
5. Travel related to my responsibilities as a UNC employee that was paid on my behalf or reimbursed to
me, excluding such travel that was paid by a Federal, state, or local government agency, an institution of
higher education as defined at 20 U.S.C. 1001(a), an academic teaching hospital, a medical center, or a
research institute that is affiliated with an institution of higher education as defined at 20 U.S.C. 1001(a).
The required details of significant financial interests I identified above are provided on attached pages.
I have no significant financial interests to disclose at this time.
INVESTIGATOR CERTIFICATION
I have read the University of Northern Colorado policy on Financial Conflict of Interest Pertaining to Sponsored Programs,
and I understand my responsibilities thereunder. I agree to comply with conditions or restrictions that may be imposed by
the university to manage my real or perceived financial conflicts of interest. I understand that significant financial interests
disclosed here do not necessarily constitute a financial conflict of interest, and I may be asked to provide additional
information if it is needed to determine whether a financial conflict of interest does exist.
I certify that to the best of my knowledge, the information provided here is a complete and accurate disclosure of my
significant financial interests as of the date of my signature below.
NOTE: Only manual or certified digital signatures
are allowed. Signature must also be dated.
Signature Date
All information provided and records related to this disclosure will be held in confidence to the extent permitted by law and in
accordance with UNC’s Policy on Financial Conflict of Interest Pertaining to Sponsored Programs and the Implementing Procedures.
Approved: Date: 05.2016
Award #:
#:
Proposal #:
###:
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Completed 30 August 2020

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