UCSC 900IL FORM Office of Research Compliance Administration (ORCA)

PUBLIC HEALTH SERVICES (PHS)-FUNDED STUDY TEAM MEMBERS SUBJECT TO FINANCIAL DISCLOSURE REQUIREMENT

UCSC FORM 900IL INSTRUCTIONS

1. Prior to proposal submission, the Principal Investigator (PI) must submit a 900IL form along with a 900D form for him/ herself and for each Investigator listed on the 900IL. Proposals and supplemental funding requests may not be submitted by OSP until the PI has submitted these required forms.

2. Submission of the 900IL and 900D forms is also required for non-competing continuation awards:

· when a new Investigator is added to a project

· within 30 days of an Investigator acquiring or discovering a new significant financial interest

· at least annually throughout the life of a grant or contract.

3. Investigators having a Significant Financial Interest (SFI) that is reasonably related to the Investigators’ Institutional Responsibilities must also complete the COI Addendum Form prior to release of award funds.

4. Disclosure and committee review of the disclosures must be complete prior to release of awards funds, or prior to submission of progress reports in subsequent years. Investigators must allow sufficient time for committee review of disclosures.

First and Last Names of Principal Investigator:

Phone Email: OSP SC#

Proposal Title:

To complete this form, the Principal Investigator (PI) must list all Investigators below.
An Investigator is defined as any personnel on a PHS funded project who is responsible for the design, conduct, or reporting of the research. This should always include the PI and all senior/key personnel, but could also include other researchers, collaborators or consultants that meet the definition.
PLEASE NOTE: If personnel are not currently known, you may put TBD in the form, however, the PI is responsible for ensuring that all Investigators are included on a revised form submitted to OSP and that their disclosures are reviewed prior to starting work on the project.

First and last names, e-mails and phone numbers and role (Co-PI, Key Personnel, Researcher…) of all other Investigators: a

Investigator First and Last Name / e-mail / Phone Number / Role / 900D check /