Award Specific Report for Key Personnel on PHS Awards Public Health Service (PHS) regulations on Conflicts of Interest require that prior to the expenditure of any PHS funds on awards issued on or after Aug 24, 2012 (includes funding from NIH, FDA, CDC, etc.), any significant financial interests of an Investigator planning to participate in the research must be disclosed to Cornell and any financial conflicts of interest related to the PHS award must be managed. In order to meet this requirement, each investigator named on the award must complete and submit this form to the Cornell COI office. No expenses can be charged to the PHS award unless the disclosure has been submitted and reviewed and any identified conflicts of interest with the research addressed per University policies. The Cornell COI office will contact you if any further information is needed. If you have any questions about this and other COI policies, requirement, the form or the process, please contact the COI office at 255-2214 or coi@cornell.edu, or visit the Cornell COI website at Please provide the following information about yourself. Name (Last, First) Cornell Net ID Email address Please provide the following information about the PHS grant proposal for which you are submitting this report Name of Sponsor/Funding agency Proposal (OSP) Number Name of the Principal Investigator (PI) (Last Name, First Name) Title of the Grant Proposal
Award Specific Report for Key Personnel on PHS Awards Public Health Service (PHS) regulations on Conflicts of Interest require that prior to the expenditure of any PHS funds on awards issued on or after Aug 24, 2012 (includes funding from NIH, FDA, CDC, etc.), any significant financial interests of an Investigator planning to participate in the research must be disclosed to Cornell and any financial conflicts of interest related to the PHS award must be managed. In order to meet this requirement, each investigator named on the award must complete and submit this form to the Cornell COI office. No expenses can be charged to the PHS award unless the disclosure has been submitted and reviewed and any identified conflicts of interest with the research addressed per University policies. The Cornell COI office will contact you if any further information is needed. If you have any questions about this and other COI policies, requirement, the form or the process, please contact the COI office at 255-2214 or coi@cornell.edu, or visit the Cornell COI website at Please provide the following information about yourself. Name (Last, First) Cornell Net ID Email address Please provide the following information about the PHS grant proposal for which you are submitting this report Name of Sponsor/Funding agency Proposal (OSP) Number Name of the Principal Investigator (PI) (Last Name, First Name) Title of the Grant Proposal
Award_Report.docx