Instructions: In each section please specify the actions that have been, and shall be, taken to manage the financial conflict of interest. The purpose of this Management Plan is “to reduce or eliminate the financial conflict of interest, to ensure, to the extent possible, that the design, conduct, and reporting of research will be free from bias.”
1. General Proposal Information
Project Working Title: Click here to enter text.
Principal Investigator/Project Director: Click here to enter text.
Phone: Click here to enter text. Fax: Click here to enter text. E-mail: Click here to enter text.
Department/School: Click here to enter text.
Other Belmont Faculty Involved: Click here to enter text.
Investigatorwith a FCOI: Click here to enter text.
2. Role, Principle Duties, and responsibilities of the conflicted Investigator in the Research Project.
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3. Conditions of the Management Plan that will ensure and/or eliminate the FCOI. Please include full disclosure plans, measures to preserve research integrity, student safeguards (if applicable), and potential divestitures of the financial interest.
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4. How will these Conditions, and the Management Plan, safeguard objectivity in the research project?
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5. How will the Management Plan be monitored to ensure the Investigator’s compliance? Include who will ensure compliance, when they will review the Plan to ensure its implementation, and how they will review it.
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5. Additional Information about the FCOI, Investigator(s), or research project that may reduce and/or eliminate the FCOI.
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6. Investigator’s Agreement to the Management Plan
Investigator Certification: My signature below certifies that 1) I have freely participated in developing this management plan; 2) I will adhere to the requirements of the management plan at all times; 3) I will report any additional financial conflicts of interest that may arise hereafter; 4) I will disclose my financial conflict of interest when appropriate, to include disclosures arising from any abstracts, presentations, press releases, publications, and any future proposals that are directly or indirectly related to the current project; and 5) I have completed and submitted a Significant Financial Interest Disclosure Form if applying for aPublic Health Service/NIH or NSF award.
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Investigator with FCOI Date
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Principal Investigator/Project Director Date
Administrative Approvals: The Provost will review this plan to ensure it complies with Belmont University’s FCOI policy, and all applicable federal laws and regulations. The Vice President for Administration and University Counsel is the final approval authority who will certify that the management plan complies with all applicable requirements.
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Provost Date
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Vice President for Administration and University Counsel Date
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Rev.07/12/2013