Financial Conflict of Interest(FCOI) Disclosure Form

Per the Pediatric Nephrology Research Consortium (PNRC) FCOI policy, any person, regardless of title or degree that is working on a Public Health Service (PHS)/National Institute of Health (NIH) funded project must complete a FCOI form. Reporting includes a person's significant financial interest (SFI) as well as those of their spouse and dependent children. 

The FCOI policy pertains to a person's PNRC responsibilities, not their current medical/academic institutional roles or responsibilities. 

The Investigator must determine the professional activities they perform on behalf of the Institution "PNRC" (e.g., the applicant and/or recipient institution). Please refer to the "Institutional responsibilities" in the PNRC FCOI policy. Activities may include research, research consultation, fundraising, product or services development, product testing, teaching, professional practice, institutional committee membership, and service on panels such as Institutional Review Boards or Data Safety and Monitoring Boards. 

Note- this is a PNRC internal form. It will not be submitted to other entities. If a FCOI is identified the following information will be made available to the PHS/NIH and publicly accessible: Your name, your title and role with respect to the project, name of entity in which the SFI is held, the nature of the SFI and approximate dollar value within a range).