аЯрЁБс>ўџ EGўџџџDџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС` љП-4bjbjъъ h6э€э€!џџџџџџЄˆˆˆˆˆˆˆ$іd^^^^,ŠZ TВ|.... vƒDЧ$ЃЅЅЅЅЅЅ$rhкœЩEˆы  ыыЩˆˆ..лЭЭЭыˆ.ˆ.ЃЭыЃЭЭrwTˆˆw.І ›nliŒХ^:ЫЃ$0Tйžv;ˆvwvˆw,ЭыыыЩЩУ ыыыTыыыыZ Z Z ^Z Z Z ^Ќ$а"ђˆˆˆˆˆˆџџџџ Investigator Financial Disclosure Policy (Applicable to all Sponsored Project Proposals) What is required? Federal regulations require institutions to have policies and procedures in place that ensure that investigators disclose any significant financial interest that may present an actual or potential conflict of interest in relationship to externally sponsored projects. Such disclosures must be made prior to the submission of a proposal for funding,* and institutions must develop specific mechanisms by which conflicts of interest will be satisfactorily managed, reduced, or eliminated prior to the expenditure of any funds on an award. * If a new reportable significant conflict of interest arises at any time during the period after the submission of the proposal through the period of the award, the filing of a disclosure is also required. Who is covered? “Investigator” means the principal investigator/project director, co-principal investigators, and any other person at the University who is responsible for the design, conduct, or reporting of research, educational, or service activities funded, or proposed for funding, by an external sponsor. In this context, the term “Investigator” includes the Investigator’s spouse and dependent children. What must be disclosed? Each Investigator shall disclose all significant financial interests: (i) that would reasonably appear to be affected by the research, educational, or service activities funded, or proposed for funding, by an external sponsor; or (ii) in entities whose financial interests would reasonably appear to be affected by such activities. What is covered? “Significant financial interests” means anything of monetary value, including, but not limited to, salary or other payments for services (e.g. consulting fees or honoraria); equity interests (e.g., stocks, stock options or other ownership interests); and intellectual property rights (e.g., patents, copyrights and royalties from such rights). The term does not include: (1) Salary, royalties, or other remuneration from Brandeis; (2) Income from seminars, lectures, or teaching engagement sponsored by public or nonprofit entities; (3) Income from service on advisory committees or review panels for public or non-profit entities; or (4) An equity interest that when aggregated for the Investigator and the Investigator’s spouse and dependent children, meets both of the following tests: does not exceed $10,000 in value as determined through reference to public prices or other reasonable measures of fair market value, or, constitute more than a five-percent ownership interest in any single entity; or (5) Salary, royalties or other payments that when aggregated for the Investigator and the Investigator’s spouse and dependent children over the next twelve months, are not expected to exceed $10,000. Disclosure Procedures: (1) All Investigators must disclose their significant financial interests utilizing this form and attaching all required supporting documentation. The completed form and packet must be submitted with the proposal and Proposal Summary Form to the Office of Grant, Contract and Patent Administration. Supporting documentation should be submitted in a sealed envelope marked confidential. (2) In accordance with Federal regulations, a complete disclosure must be made by Investigator(s) prior to submission of the proposal. (3) Resolutions to conflicts of interest will be incorporated into a Memorandum of Understanding (MOU) between the Investigator(s) and the University [signed by Investigator(s), the Department Chair, and the Dean/Director] prior to expenditure of any award funds. Issued: September 1, 1995 Significant Financial Interest Disclosure (Applicable to all Sponsored Project Proposals) Faculty/Staff Name  FORMTEXT       Department  FORMTEXT       Proposal Title  FORMTEXT       Proposal Submitted to  FORMTEXT       I am disclosing the following significant financial interests (check one) and attaching supporting documentation (in an envelope marked confidential) that identifies the business enterprise or entity involved and the nature and amount of the interest: (“Significant financial interests” are defined as interests or projected annual income valued at greater than $10,000 or an equity or ownership interest of more than five percent held by an Investigator and the Investigator’s spouse or dependent children. See page 1 for exempt interests.)  FORMCHECKBOX  Salary or other payment for services (e.g., consulting fees or honoraria).  FORMCHECKBOX  Equity interests (e.g. stocks, stock options, or other ownership interests).  FORMCHECKBOX  Intellectual property rights (e.g., patents, copyrights, and royalties from such rights).  FORMCHECKBOX  Other significant financial interest of the Investigator that possibly could affect or be perceived to affect the results of the research, educational, or service activities funded or proposed for funding. Further I agree: To update this disclosure during the period of the award as new reportable significant financial interests are obtained. To cooperate in the development of a Memorandum of Understanding (MOU) that constitutes a conflict of interest “resolution plan.” To comply with any conditions or restrictions imposed by the University to manage, reduce, or eliminate actual or potential conflicts of interest or forfeit the award. To have a fully-executed MOU in place prior to making any expenditures of sponsored project funds. Signed:__________________________________ Date: ____________ (Original signature only—a “per” signature is not acceptable.) Endorsements: I have reviewed the significant financial interest disclosure and believe that it will be possible to develop and execute, prior to expenditure of award funds, an MOU to manage, reduce, or eliminate any actual or potential conflict of interest; and, therefore, I recommend that proposal be submitted to the agency at this time. Department Chair: ______________________________________ _______________ Signed Date OGCPA # )*[mn˜ Н ˆ Š X h i ѕ  3 T U ^op‘бсфlp-DEЙХ*OДѕэукдЦЕЦЋукдЦкдЦšЦˆкдšЦЕЦˆtˆкдˆ_ˆ_ˆ)hгPм6B*CJOJQJ]^JaJphџ&hгPм>*B*CJOJQJ^JaJphџ#hгPмB*CJOJQJ^JaJphџ hгPм6CJOJQJ]^JaJhгPмCJ^JaJ hгPм5CJOJQJ\^JaJhгPмCJOJQJ^JaJ hгPм^JhгPм5\^JhгPмCJ^JaJhгPмCJaJhгPм5CJ\aJ#*[nˆ X i ѕ  U і ]^pф!ˆяc,-њђ№чж№Э№ФППН№ДЏЏЏЏЏН & F„Ыd№]„Ы & F„hd№^„h„Иd№]„И„3„l„ќўdШ]„3^„l`„ќў„{d№]„{$dШa$$a$-4§-EШPВДъь№FЈњ>ˆортn‘яOМ§јјјііііёьчччччрлвЩЩЩ„8d№^„8„ŽdШ]„Žd№$ЄTa$gd7@\$a$$a$ & FДшью№DFЈвдшъьіјњ,.0:<>`bv№фкаХНГЏž‘}žfžaZЏž‘FžfžaЏž‘'jrh7@\hгPм>*B*Uphџ h7@\h7@\ h7@\>*,jh7@\h7@\>*B*UmHnHphџu'jh7@\hгPм>*B*Uphџh7@\h7@\>*B*phџ!jh7@\h7@\>*B*Uphџh7@\hгPмCJ^JaJhгPмCJaJhгPм5CJ\aJhгPмB*^Jphџh7@\B*^JphџhгPмB*CJaJphџhгPм5B*CJ\aJphџvxz„†ˆДЖИЬЮакмртmn‘’ыкУкОЗГкІ’кУкЗ†ug]C2jh7@\h7@\B*CJOJQJU^JaJphџhгPмCJ^JaJhгPмCJOJQJ^JaJ hгPм5CJOJQJ\^JaJhгPмB*CJaJphџ'jdh7@\hгPм>*B*Uphџh7@\h7@\>*B*phџh7@\ h7@\h7@\ h7@\>*,jh7@\h7@\>*B*UmHnHphџu!jh7@\h7@\>*B*Uphџ'j№h7@\hгPм>*B*Uphџ’ ЁЂЃя№ўџOP^_`aМНЫЬЭЮъЭГъЅГъˆГzЅГъ]ГzЅГъ@ГъЅ8j4h7@\hгPмB*CJOJQJU^JaJphџ8jРh7@\hгPмB*CJOJQJU^JaJphџh7@\CJOJQJ^JaJ8jLh7@\hгPмB*CJOJQJU^JaJphџhгPмCJOJQJ^JaJ2jh7@\h7@\B*CJOJQJU^JaJphџ8jиh7@\hгPмB*CJOJQJU^JaJphџ)h7@\h7@\B*CJOJQJ^JaJphџМЏ)ЌUЙКї8 G !п!ь!4-4ђ№ыыыыщпв№ЭЫМГщ„Pd№^„P„P„дяd№ЄЄ^„P`„дяd№ „~„КџdШ^„~`„Кџ „€„€щ^„€`„€щ & F „S„8d№]„S^„8ЎЏКСуъії8 F G !!Ђ!о!п!є!444,4-4їёпдЩдЩСЗїёІ˜‹~thfZhK?hгPмB*CJaJphџhгPм5B*CJ\aJphџha>1B*CJaJphџUhгPмB*CJaJphџhгPмCJ^JaJha>15CJ\^JaJhгPм5CJ\^JaJhгPмCJOJQJ^JaJ hгPм5CJOJQJ\^JaJhгPмCJ^JaJhгPмB*phџh7@\5B*\phџhгPм5B*\phџ#hгPмB*CJOJQJ^JaJphџ hгPм^JhгPм5\^J_________________ Issued: September 1, 1995 2 00PАа/ Ар=!Аќ"АH#t$”%ААаАа а2 00PАа/ Ар=!Аќ"Ај#t$”%ААаАа аrDџџџџName~Dџџџџ DepartmenttDџџџџText1tDџџџџText2tDџџџџeCheck1tDџџџџeCheck2tDџџџџeCheck3tDџџџџeCheck4†œ@@ёџ@ NormalCJ_HaJmH sH tH DA@ђџЁD Default Paragraph FontRi@ѓџГR  Table Normalі4ж l4жaі (k@єџС(No List dўOёџђd Default1$7$8$H$-B*CJOJQJ^J_HaJmH phsH tH 0ўOёђ0 CM1 B*^Jphџ4ўOёђ4 CM8ЄK B*^Jphџ4ўOёђ4 CM9ЄО B*^Jphџ6ўOёђ6 CM11Єо B*^Jphџ6ўOёђ6 CM5d№ B*^Jphџ6ўOёђ6 CM6d№ B*^Jphџ6ўOёђ6 CM12Є№ B*^Jphџv! 6џџџџ 46џџџџџџ z™џџ z™vw!*[nˆXiѕUі]^pф!ˆяc , - E Ш P YvxЃд§Dopqn‘яOМЏ)ЌUЙКї8Gпь#Œ(ЅŒ(jŒ(ЌŒ(|hџŒ()Œ(ЌŒ(|hŒ(ЌŒ(|hŒ(|hŒ(|hŒ(|hŒ(ЌŒ(|hŒ(|hŒ(|hŒ(|hŒ(|hŒ(|hŒ(|hŒ(ЌŒ(|hџŒ(ОŒ(|hŒ(|hм(Ќм(Ѕм(jм(Ќм(Ќм(Ќм(Ќм(Ќм(jм(Vм(jм(|hм(|hм(|hм(|hм(Ќм(|hм(|hм(|hм(|hм(|hм(Ќм(jм(Ќм(Vм(PSм(PSм(PSм(j*[nˆXiѕUі]^pф!ˆяc , - E Ш P YZuvxЃд§Dopqn‘яOМЏ)ЌUЙКї8Gпь#˜00 3€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜ 0€€˜ 0€€˜0€€˜0€€˜0€€˜ 0€€˜ 0€€˜ 0€€˜ 0€€˜ 0€€˜0€€˜0€€˜ 0€€˜ 0€€˜ 0€€˜0€€˜0€€˜0€€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜ 0€€˜ 0€€˜ 0€€˜ 0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€Дv’-4-М-4-4щѕћ 0<B[gm‘ЁяџO_МЬ!Fџ•„Fџ•„Fџ•„Fџ•„G•$G•$G•$G•$№8№@ёџџџ€€€ї№’№№0№( № №№B №S №ПЫџ ?№!џџName DepartmentText1Text2Check1Check2Check3Check4ч1\’№PН#ќCnЂ`Э#VW#ћ§ЃэaКРТ#::::гopp‘ЃяOaМЮСуъіЂоє ##1Іѕ–ѕу ƒџџџџџџџџџ<кФУ§#џџџџџџџџџ# ћтЄїэsџџџџџџџџџ`чUчШџџџџџџџџџ1Іѕ–# ћт`чU<кФџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџхY a>17@\Ж`гPмџ@іћDЖ?іі@є!А@ААА4@Аh@џџUnknownџџџџџџџџџџџџG‡z €џTimes New Roman5€SymbolG& ‡z €џArialHelveticaS PalatinoBook Antiqua"AŒ№аhvš—Fvš—F™ˆ +™ˆ +$№ЅРxxƒ23ƒ№пп №џ?џџџџџџџџџџџџџџџџџџџџџЖ`2џџ)Investigator Financial Disclosure Policy svannesssvanness    ўџр…ŸђљOhЋ‘+'Гй0œ˜Ьиьј ,8 X d p|„Œ”ф,Investigator Financial Disclosure Policy  svanness Normal.dot svanness2Microsoft Office Word@FУ#@Ь€PiŒХ@Ь€PiŒХ™ˆўџеЭеœ.“—+,љЎ0  hpŒ”œЄ ЌДМФ Ь фBrandeis University+  *Investigator Financial Disclosure Policy Title ўџџџ !"#ўџџџ%&'()*+,-./0123ўџџџ56789:;ўџџџ=>?@ABCўџџџ§џџџFўџџџўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџRoot Entryџџџџџџџџ РFp‚zliŒХH€Data џџџџџџџџџџџџ1Tableџџџџ$’WordDocumentџџџџh6SummaryInformation(џџџџџџџџџџџџ4DocumentSummaryInformation8џџџџџџџџ<CompObjџџџџџџџџџџџџqџџџџџџџџџџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџ џџџџ РFMicrosoft Office Word Document MSWordDocWord.Document.8є9Вq