This Document Is Required of All Subrecipients Applying for Public Health Service (PHS)

This document is required of all subrecipients applying for Public Health Service (PHS) funding UNLESS the subrecipient is listed on the FDP Institutional Clearinghouse of institutions compliant with the PHS Financial Conflict of Interest regulations.

All Investigators on a PHS proposal must comply with 42 CFR Part 50 Subpart F and 45 CFR Part 94. In order to ensure compliance with the regulations, check one of the following:

Subrecipient certifies it is in compliance with 42 CFR Part 50 SubPart F. Subrecipient’s investigators will comply with the Subrecipient’s policy relating to the disclosure of Significant Financial Interests, and will report all identified Financial Conflicts of Interest to ISU via email to at least five (5) business days prior to Subrecipient expending funds under this project. After the initial report, Subrecipient will report to ISU within 30 days of determining the existence of a financial conflict of interest pertinent to the project.

Subrecipient does not have a conflict of interest policy compliant with 42 CFR Part 50 SubPart F and Subrecipient’s investigators will be subject to ISU’s Conflict of Interest and Commitment Policy for disclosing significant financial interests that are directly related to the Subrecipient’s involvement in the project.

Prior to proposal submission, Subrecipient’s Investigators must:

1)Fill out the PHS COI Disclosure Form and email it to from their Subrecipient email account; and

2)Prior to execution of the subaward, Subrecipient Investigators must Affiliate with Iowa State University on the CITI website and complete the Conflict of Interest Mini-Course. COI Training Instructions

If ISU determines that any of Subrecipient’s Investigators have a Financial Conflict of Interest (FCOI), Subrecipient must manage such FCOI and provide a copy of the management plan to prior to the execution of the subaward. For additional information regarding ISU’s Conflict of Interest and Commitment Policy, see ISU’s Office of Research Integritywebsite.

APPROVED FOR SUBRECIPIENT

The certification above has been read, signed and made by an authorized official of the subrecipient.

Signature of Subrecipient’s Authorized Official

Type or print name and title of Authorized Official

Name of Subrecipient Institution

Date

Revised 2/19/16