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This document serves as a formal declaration of potential conflicts of interest regarding the research activities of the Principal Investigator or Sub-Investigator involved in clinical trials.
Note:
Date
Subject:
Declaration of Conflict of Interest (COI) for Principal Investigator and/or Sub-Investigator
Type of document:
Declaration
Institution:
ST. CABRINI MEDICAL CENTER – ASIAN EYE INSTITUTE ETHICS REVIEW COMMITTEE
Target audience:
Ethics review committee members
Period of validity:
N/A
Date of approval:
N/A
Date of changes:
N/A
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2026
Region / City:
Global
Topic:
Conflicts of Interest (COI)
Document Type:
Guidance Document
Organization:
ILCOR
Author:
ILCOR COI Committee
Target Audience:
ILCOR participants, volunteers, staff, and other stakeholders
Period of Validity:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Note:
Year
Region / city:
Great Britain
Theme:
Organic certification, import procedures
Document type:
Official form
Institution:
CERES
Author:
CERES
Target audience:
Exporters, importers, and traders in organic products
Note:
Year
Year:
2023
Region / City:
Oregon
Topic:
Conflict of Interest Disclosure
Document Type:
Disclosure Form
Organization / Institution:
Oregon Department of Transportation
Author:
Oregon Department of Transportation
Target Audience:
Firms under contract or proposing to enter into a contract with ODOT
Period of Effectiveness:
Ongoing
Approval Date:
Not specified
Date of Changes:
Not specified
Note:
Year
Institution:
Blessing-Rieman College of Nursing and Health Sciences
Department:
Institutional Review Board (IRB)
IRB Address:
13609 N. Marx Drive, Quincy, IL 62305
Document Type:
Administrative disclosure form
Subject:
Conflict of Interest (COI) disclosure for research studies
Applicable To:
Research studies and projects under IRB review
Submission Format:
Microsoft Word document
Submission Email:
[email protected]
Required Completion Method:
Typed form only
Sections:
General Information; Nature of the Conflict of Interest
Related Topics:
Financial interests, personal relationships, intellectual property, research sponsorship, commercialization
Geographic Location:
Quincy, Illinois, United States
Date:
September 2019
Year:
2023
Region / City:
N/A
Subject:
Conflict of Interest
Document Type:
Policy
Organization / Institution:
American Academy of Sleep Medicine (AASM)
Author:
N/A
Target Audience:
Board Members, Committee Members, Sleep Medicine Professionals
Period of Validity:
N/A
Date of Approval:
N/A
Date of Amendments:
N/A
Year:
2023
Region / City:
Global
Topic:
Conflict of Interest Management
Document Type:
Guidelines
Organization:
ILCOR
Author:
ILCOR
Target Audience:
ILCOR Participants, Task Force Leaders, Committee Members
Effective Period:
Ongoing
Approval Date:
2023-01-01
Date of Changes:
None
Year:
2018
Month:
April
Topic:
Conflict of Interest disclosure management and review procedures
Document type:
Training exercises manual
System / platform:
COI Module (Click system)
Organization:
Research Foundation for SUNY
User roles referenced:
Principal Investigator, COI Discloser, COI Administrator, COI Committee Member, COI Monitor
Processes covered:
Disclosure submission, administrative review, ancillary review, committee meeting procedures, management/mitigation plan oversight
Content structure:
Step-by-step exercises with questions for system navigation and workflow practice
Primary activities:
Logging in, editing certifications, submitting disclosures, assigning committees, preparing agendas, convening meetings, recording decisions, correspondence preparation
System access reference:
https://pacsstg3.rfsuny.org
Year:
20____
Region / City:
Randall County, Texas
Topic:
Legal Procedure
Document Type:
Motion
Organ / Institution:
Randall County District Court
Author:
[Attorney for Defendant]
Target Audience:
Legal Professionals, Court Officials
Period of Effectiveness:
From the date of approval
Date of Approval:
[DATE OF CASE ASSIGNMENT]
Date of Changes:
None indicated
Context:
This is a legal document requesting the appointment of a private investigator to assist a defendant in preparing a defense in a criminal case.
Note:
Year
Subject:
Clinical Trials, Medical Research
Document Type:
Template
Organization / Institution:
EU Clinical Trials Expert Group
Target Audience:
Sponsors of clinical trials
Note:
Year
Document type:
Checklist
Target audience:
Investigators, IRB staff
Context description:
A checklist for investigators and IRB staff to assess and ensure regulatory compliance in clinical and non-clinical research studies.
Year:
2025
Region / City:
Doha, Qatar
Topic:
Human Research Protection
Document Type:
Manual
Institution:
Virginia Commonwealth University
Author:
Huron Consulting Group
Target Audience:
Researchers, Investigators, Staff
Approval Date:
08/07/2025
Modification Date:
Not specified
Period of validity:
Not specified
Note:
Study Summary 1.1 Please provide a brief summary of the study in the table below. A complete description of the study with detailed information should be provided in the body of the protocol. For sections not applicable to the study, mark them as N/A. Study Title Study Design Primary Objective/Purpose Secondary Objective(s)/Purposes Research Intervention(s) ClinicalTrials.gov NCT # Study Population Sample Size Study Duration for individual subjects Study Specific Abbreviations/ Definitions
Background 3.1 Provide the scientific or scholarly background for, rationale for, and significance of the research based on the existing literature and how will it add to existing knowledge. :
this section should be limited to only information directly related to the research questions and objectives. Do not include your full dissertation proposal. 3.2 Describe any relevant preliminary data (e.g. pilot data).
Procedures Involved 5.1 Describe and explain the study design. 5.2 Please select the methods that will be employed in this study (select all that apply):
☐ Audio/Video Recording ☐ Psychophysiological Recording ☐ Behavioral Interventions ☐ Record Review - Educational ☐ Behavioral Observations and Experimentations ☐ Record Review - Employee ☐ Deception ☐ Record Review- Medical ☐ Focus Groups ☐ Record Review - Other ☐ Interviews ☐ Specimen Collection or Analysis ☐ Investigational Medical Device – (e.g. Medical Mobile Applications) ☐ Surveys and/or Questionnaires ☐Psychometric Testing ☐ Other Social-Behavioral Procedures Provide a description of all research procedures being performed and when they are performed. (Upload any surveys, questionnaires, interview scripts, focus group scripts, debriefing scripts, psychometric tests, stimulus materials, intervention manuals, and data collection forms on the Local Site Documents page in the IRB application.) 5.3 Describe the procedures or interventions that are going to be conducted as part of the research project, but that would have been conducted anyway, even if the research was not occurring (i.e. standard of care procedures, activities that would occur in a classroom). 5.4 Describe the procedures performed to lessen the probability or magnitude of risks of items selected in 5.2.5. 5 If accessing or collecting existing data, describe: The data that will be collected during the study (e.g. demographics, medical history, etc.). Attach the data capture sheet(s) on the Local Site Documents page in the IRB application. How the data will be obtained, including how you have the authority to access the data. The source or location of the data (e.g. USF Epic, TGH Epic, Hillsborough County School records, CANVAS records, publicly available databases, etc.). 5.6 If collecting and/or analyzing biological specimens, describe: How the biological specimens will be or have been collected. How the biological specimens will be stored. How long the biological specimens will be stored. How the biological specimens will be used. The laboratories that will be used. Whether the collected biological specimens will undergo genetic testing. If so, indicate if this study is part of a Genome Wide Association Study (GWAS) and whether the data will be forwarded to the NIH dbGaP. 5.7 If there are plans for long-term follow-up (once all research related procedures are complete), what data will be collected during this period.
Data and Specimen Storage for Future Research 6.1 If data or specimens will be banked for future research studies, describe where the data or specimens will be stored, how long it/they will b:
the process to request a release, approvals required for release, who can obtain data or specimens, and the data to be provided with specimens.
Year:
2025
Institution:
Yale University; Yale New Haven Health System
Document type:
Administrative request form
Subject area:
Human subjects research oversight
Regulatory framework:
U.S. federal human research protection regulations
Responsible body:
Institutional Review Board
Related system:
IRES IRB
Intended users:
Principal Investigators; Unaffiliated Investigators
Scope:
Authorization and oversight of unaffiliated investigators
Jurisdiction:
United States
Ethical standards referenced:
Belmont Report; HHS 45 CFR 46; FDA 21 CFR 50; HIPAA
Approval authority:
Yale/YNHHS Institutional Signatory Official
Note:
Year
Document Type:
Clinical Research Delegation Log
Author:
Principal Investigator / Investigator of Record
Target Audience:
Research Staff
Document type:
Agreement
Institution:
Oregon State University
Program:
Human Research Protection Program
Oversight body:
Institutional Review Board
Research area:
Human subjects research
Parties:
Individual Investigator; Oregon State University
Compliance framework:
International, federal, state, and local laws and regulations
Training requirements:
Research ethics training; CITI or equivalent
Approval requirement:
Institutional Review Board review and approval
Signature fields:
Investigator; HRPP Administrator
Year:
1989
Region / City:
Australia
Theme:
Clinical trials, therapeutic goods, medical research
Document Type:
Operational procedures
Organization / Institution:
SESLHD
Author:
SESLHD
Target Audience:
Coordinating Principal Investigators, Sponsors, Clinical Trial Coordinators
Period of Action:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Note:
Year
Document type:
Template
Institution / organization:
EU Clinical Trials Expert Group
Target audience:
Sponsors of clinical trials