DIRECTIONS FOR COMPLETING YOUR 2012 COMBINED CONFLICT OF INTEREST FORM (UPMC/UNIVERSITY OF PITTSBURGH)
for DUALLY EMPLOYED INDIVIDUALS
The formmust be accessed through My Hub.
Click on the Human Resources link.
Then select the COI link in the lower left hand corner.
Scroll down andselect the appropriate button to begin the disclosure.
Please Note: Individuals who also have an appointment at the University of Pittsburgh should fulfill the University’s COI disclosure requirement using this system by choosing to complete the UPMC/Pitt combined form which will generate a University of Pittsburgh Faculty/Researcher form in the University’s Superform system. You will need your HSConnect login username and password to finalize your disclosure in the University’s Superform system.
If you choose to complete the UPMC/Pitt Combined Form you will also be asked whether you are required to complete the Designated Administrator/Staff Form[i].
Select “Y or N” and select the Enter UPMC/PITT Combined Form button.
At this point, you may Create a New Disclosure, or Copy Your History from the previous year (you will be asked to edit it to make it your current disclosure).
To create a new disclosure, select the Create a New Disclosure button.
To Copy Your History, follow the instructions in the boxbelow.
Select the “Copy this Disclosure into a New Disclosure Form” tab.
To ensure that your disclosure successfully copied over,look for the GREENbox. Next, select Edit “Open” Disclosure.
Read each question and select “Y or N.” Then “Submit” your answer.
If you select “Y” you will need to add and/or verify each organization. To add a new Organizationclick the Drop Down button to the right of the Organization Field, then type in the name of the Organization you wish to add in the search box. Make sure all the below fields are completed and “Save Changes.” Complete the above steps for each Organization you wish to disclose; once all have been added,“Return to Questions.”
Please note: If you chose to copy your history, scroll down to review and verify each entry. If you do not need to add any organizations select the “Return to Questions”buttonand continue with your disclosure.
Once each question has been completed and you are satisfied with your answers, select the Finalize Disclosure button and read the Final Attestation.
If you are still satisfied with your answers, select the Submit button. If you are not satisfied with your answers, select the Return to Questions button to make changes.
After clicking “Submit,” the system creates a University Faculty/Researcher (and Designated Administrator/Staff form, if you selected this at the beginning) COI disclosure in the University’s Superform system. You will be directed to log into the University’s system in order to print out your University Signature Page(s). Log in using your HS Connect username and password.
After logging in, you will be taken directly to your Filing History page. You will see the message “Import Successful” at the top, and the form(s) you just created will be highlighted in green.
Please note: If you completed a Designated Administrator/Staff form, it will be listed separately below the list of Faculty/Researcher forms.
Click the “View & Print” link next to the form(s) you just created to open it in another window.
Print your Signature Page(s) by clicking the print icon in your browser.
Sign your Signature Page(s) and submit:
- Faculty/Researcher Signature Page to your supervisor (e.g., department chair) for signature by April 15[ii].
- Designated Administrator/Staff Signature Page to the next higher administrator who is at least at the level of director or department chair by April 15.
1
[i] The Designated Administrator/Staff form must be completed by individuals who are full-time or part-time University administrators classified as Administrator IV or above, or those of other classifications (including faculty) who are in a position to make, direct, or materially influence University business decisions (such as deans, department chairs, center directors, and others who have significant input over the selection of outside vendors or providers of services), or other individuals as directed by their supervisors.
[ii] If April 15 falls on a weekend or holiday, the filing deadline is the next business day.