Research Policy Handbook

EVALUATION OF FINANCIAL INTERESTS

Attachment A to Research Policy Handbook 4.2,
PHS and NSF Requirements Regarding Financial Disclosures and Agency Notifications

Date: August 22, 2012

Principal Investigators must complete a Proposal Development & Routing Form (PDRF) in order to document that all requirements related to the submission of a funded research proposal have been met. If the PI indicates the existence of a related financial interest, the PDRF links to questions about those financial interests that may reasonably appear to be related to the research project, including:

1. Name of company/organization (foundation, society, other)    ________________

2. What is the nature of your activity/financial interest with the company/organization?  Check all that apply

   __ Board of Directors membership
   __ Advisory Board membership
   __ Consultant (other than Advisory Board or Board of Directors membership)
   __ Licensing of your Stanford or non-Stanford intellectual property
   __ Ownership of stock or stock options or other ownership interests
       (excluding investments for which you do not directly control investment
         decisions, such as mutual funds)
   __ Payment for royalties for inventions (not paid through Stanford)
   __ Payment for lectures
   __ Payment for preparation of papers or reports   
   __ Payment for product evaluation
   __ Legal consultant or expert witness
   __ Executive or other employee position with company/organization
   __ This is a financial interest/activity of my spouse/domestic partner or dependent child   

3. What is the total amount of your financial interest (or that of your spouse/domestic partner or dependent children) in this company/organization?

   __ $1 - 4,999

   __ $5K - $9,999K

   __ $10K - 19,999K

   __ $25 - 49,999K

   __ $50K - 99,999K

   __ $100 - 199,999K

   __ greater then $200,000

4. If this entity is a company, is it

   __ Publicly traded or
   __ Privately held or Start Up

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