Fillable FINANCIAL CONFLICT of INTEREST SUBRECIPIENT CERTIFICATION of COMPLIANCE (University of Northern Colorado)

Fill Online, Printable, Fillable, Blank FINANCIAL CONFLICT of INTEREST SUBRECIPIENT CERTIFICATION of COMPLIANCE (University of Northern Colorado) Form

Use Fill to complete blank online UNIVERSITY OF NORTHERN COLORADO pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FINANCIAL CONFLICT of INTEREST SUBRECIPIENT CERTIFICATION of COMPLIANCE (University of Northern Colorado)

On average this form takes 5 minutes to complete

The FINANCIAL CONFLICT of INTEREST SUBRECIPIENT CERTIFICATION of COMPLIANCE (University of Northern Colorado) form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

U.S.A. forms for University of Northern Colorado

BROWSE UNIVERSITY OF NORTHERN COLORADO FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
FINANCIAL CONFLICT of INTEREST SUBRECIPIENT CERTIFICATION of COMPLIANCE
Public Health Service Funded Projects
Subrecipient Organization Information:
Legal Name:
Authorized Official: Email:
Title: Phone:
University of Northern Colorado Information:
Principal Investigator Name:
Project Sponsor:
Source of Funding:
Project Title:
Subrecipient Certification of Financial Conflict of Interest Compliance (check the appropriate response):
I certify to the following:
Subrecipient has implemented and is enforcing a written policy of financial conflict of interest
compliant with the Public Health Service (PHS) provisions of 42 CFR Part 50, Subpart F and 45 CFR
Part 94. All Subrecipient investigators (individuals responsible for the design, conduct or reporting of
the proposed project) have made the required disclosures in accordance with that policy. Should the
proposed project be funded, Subrecipient will provide information related to any identified financial
conflict of interest to the University of Northern Colorado prior to the execution of a sub-award; or,
in cases where a disclosure is made during the course of the sub-award, within 45 days of receiving
the Investigator’s disclosure.
Or:
Subrecipient has not implemented a written policy of financial conflict of interest compliant with
Public Health Service (PHS) provisions of Chapter IV, Part A of the current Award and Administration
Guide. Subrecipient investigators (individuals responsible for the design, conduct or reporting of the
proposed project) involved on this project will follow the Financial Conflict of Interest Policy of the
University of Northern Colorado. Names of all Subrecipient investigators on the proposed project
are identified below, and a University of Northern Colorado Subrecipient Disclosure of Significant
Financial Interests Form has been completed and is attached for each investigator.
Investigator Name
Position or Title
1.
2.
3.
4.
Signature of Subrecipient Authorized Official Date
The signed Compliance form with Investigator Disclosure forms should be faxed to
Sherry May at 970-351-
1934 or emailed as attachments to sherry.may@unco.edu.
05.2016
Clear Form
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

FINANCIAL CONFLICT of INTEREST SUBRECIPIENT CERTIFICATION of COMPLIANCE (University of Northern Colorado)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document