UNIVERSITY of WYOMING
SIGNIFICANT FINANCIAL INTEREST DISCLOSURE
(applicable to all sponsored project proposals)

Significant Financial Interest Disclosure form in Word format 6.0

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 award or acceptance of 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 or educational 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 directly and significantly affected by the research or educational activities funded, or proposed for funding, by an external sponsor; or
(ii) in entities whose financial interests would reasonably appear to be directly and significantly 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 institution;
(2) income from seminars, lectures, or teaching engagements sponsored by public or nonprofit entities; income from service on advisory committees or review panels for public or nonprofit entitles; or
(3) income from service on advisory committees or review panels for public or nonprofit entitles; or
(4) financial interests in business enterprises or entities if the value of such interests do not exceed $5,000 (or $5,000 per annum if such interests represent salary, fees or other continuing payments) or represent more than 5% ownership interest for any one enterprise or entity when aggregated for the investigator and the investigator's spouse and dependent children.

Disclosure Procedures

(1) All investigators must disclose their significant financial interest utilizing this form and attaching all required supporting documentation. The completed form and packet must be submitted with the proposal and greensheet to the Office of Research. Supporting documentation should be submitted in a sealed envelop marked confidential.
(2) In accordance with Federal regulations, a complete disclosure must be made by investigator(s) prior to submission of the proposal to an external agency.
(3) Resolutions to conflicts of interest will be incorporated in a Memorandum of Understanding (MOU) that is executed between the investigator(s) and the Dean/Director prior to award or award acceptance.

If you have any questions, please call the Associate Vice President for Research (766-5320).

If you have any questions about this Web page please send comments to rparrish@uwyo.edu
Revised: April 16, 2008.