Conflict of Interest Disclosures for General Scientific

OMB Control No.: 0648-xxxx
Expires: xx/xx/2xxx

National Oceanic and Atmospheric Administration

CONFLICT OF INTEREST DISCLOSURE
For General Scientific and Technical Studies and Assistance

NAME:

TELEPHONE:

ADDRESS:

EMAIL ADDRESS:
CURRENT EMPLOYER:
PEER REVIEW SUBJECT: ______________________________________________________
INSTRUCTIONS
Please complete this form, sign and date it on the last page, attach a copy of your
curriculum vitae, and return the form to the NOAA Office coordinating the peer review
process. Retain a copy for your records.
It is essential that peer reviewers of NOAA influential scientific information or highly influential
scientific assessments not be compromised by any significant conflict of interest. For this
purpose, the term "conflict of interest" means any financial or other interest which conflicts
with the service of the individual because it (1) could significantly impair the individual's
objectivity or (2) could create an unfair competitive advantage for any person or
organization. Except for those situations in which NOAA determines that a conflict of interest
is unavoidable and promptly and publicly discloses the conflict of interest, no individual can be
appointed to review information subject to the OMB Peer Review Bulletin if the individual has a
conflict of interest that is relevant to the functions to be performed.
The term "conflict of interest" means something more than individual bias. There must be an
interest, ordinarily financial, that could be directly affected by the work of the peer reviewers.
Conflict of interest requirements are objective and preventive. They are not an assessment of
one's actual behavior or character, one's ability to act objectively despite the conflicting interest,
or one's relative insensitivity to particular dollar amounts of specific assets because of one's
personal wealth. Conflict of interest requirements are objective standards designed to eliminate
certain specific, potentially compromising situations from arising, and thereby protect the
individual, other peer reviewers, NOAA, and the public interest. The individual, the other peer
reviewers, and NOAA should not be placed in a situation where the findings and conclusions of
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a review could be reasonably questioned, and perhaps discounted or dismissed, simply because
of the existence of conflicting interests.
The term "conflict of interest" applies only to current interests. It does not apply to past interests
that have expired, no longer exist, and cannot reasonably affect current behavior. Nor does it
apply to possible interests that may arise in the future but do not currently exist, because such
future interests are inherently speculative and uncertain. For example, a pending formal or
informal application for a particular job is a current interest, but the mere possibility that one
might apply for such a job in the future is not a current interest.
The term "conflict of interest" applies not only to the personal interests of the individual but also
to the interests of others with whom the individual has substantial common financial interests if
these interests are relevant to the functions to be performed. Thus, in assessing an individual's
potential conflicts of interest, consideration must be given not only to the interests of the
individual but also to the interests of the individual's spouse and minor children, the individual's
employer, the individual's business partners, and others with whom the individual has substantial
common financial interests. Consideration must also be given to the interests of those for whom
one is acting in a fiduciary or similar capacity (e.g., being an officer or director of a corporation,
whether profit or nonprofit, or serving as a trustee).
The overriding objective of the conflict of interest inquiry in each case is to identify whether
there are interests – primarily financial in nature – that conflict with the individual’s review
because they could impair the individual’s objectivity or could create an unfair competitive
advantage for any person or organization. The fundamental question in each case is does the
individual, or others with whom the individual has substantial common financial interests, have
identifiable interests that could be directly affected by the use of the peer reviewer’s findings and
conclusions regarding the scientific information being reviewed?
The application of these concepts to this review for potential conflicts of interest must
necessarily be addressed in each case on the basis of the particular facts and circumstances
involved. The questions set forth below are designed to elicit information from you concerning
possible conflicts of interest that are relevant to the functions to be performed in the course of the
peer review in which you have been asked to serve.

1. FINANCIAL INTERESTS
(a) Taking into account stocks, bonds, and other financial instruments and investments including
partnerships (but excluding broadly diversified mutual funds and any investment or financial
interests valued at less than $10,000), do you or, to the best of your knowledge, others with
whom you have substantial common financial interests, have financial investments that could be
affected, either directly or by a direct effect on the business enterprise or activities underlying the
investments, by the findings and conclusions that you would prepare as a peer reviewer?
(b) Taking into account real estate and other tangible property interests, as well as intellectual
property (patents, copyrights, etc.) interests, do you or, to the best of your knowledge, others

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with whom you have substantial common financial interests, have property interests that could
be directly affected by the findings and conclusions that you would prepare as a peer reviewer?
(c) Could your employment or self-employment (or the employment or self-employment of your
spouse), or the financial interests of your employer or clients (or the financial interests of your
spouse's employer or clients) be directly affected by the findings and conclusions that you would
prepare as a peer reviewer?
(d) Taking into account research funding and other research support (e.g., equipment, facilities,
industry partnerships, research assistants and other research personnel, etc.), could your current
research funding and support (or that of your close research colleagues and collaborators) be
directly affected by the findings and conclusions that you would prepare as a peer reviewer?
(e) Could your service as a peer reviewer create a specific financial or commercial competitive
advantage for you or others with whom you have substantial common financial interests?
If the answer to all of the above questions under FINANCIAL INTERESTS is either
“no” or “not applicable,” check here
(NO).
If the answer to any of the above questions under FINANCIAL INTERESTS is
“yes,” check here
(YES), and briefly describe the circumstances on the last page
of this form.

2. OTHER INTERESTS
(a) Is the central purpose of the peer review for which this disclosure form is being prepared a
critical assessment and evaluation of your own work or that of your employer?
(b) Do you have any existing professional obligations (e.g., as an officer of a scientific or
engineering society) that effectively require you to publicly defend a previously established
position on an issue that is relevant to the scientific information that you have been invited to
review as a peer reviewer?
(c) To the best of your knowledge, will your participation in this peer review enable you to
obtain access to a competitor’s or potential competitor’s confidential proprietary information?
(d) If you have ever been a U.S. Government employee (either civilian or military), to the best
of your knowledge, are there any federal conflict of interest restrictions that may be applicable to
your service in connection with this review?
(e) Are you an employee of any sponsor or this project?
(f) If the peer review activity for which this form is being prepared involves reviews of specific
applications and proposals for contract, grant, fellowship, etc. awards to be made by NOAA or
other sponsors, do you or others with whom you have substantial common financial interests, or

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a familial or substantial professional relationship, have an interest in receiving or being
considered for awards that are currently the subject of the review being conducted by this peer
review?
(g) If the peer review activity for which this form is being prepared involves developing requests
for proposals, work statements, and/or specifications, etc., are you interested in seeking an award
under the program for which the peer review on which you have been asked to serve is
developing the request for proposals, work statement, and/or specifications – or, are you
employed in any capacity by, or do you have a financial interest in or other economic
relationship with, any person or organization that to the best of your knowledge is interested in
seeking an award under this program?

If the answer to all of the above questions under OTHER INTERESTS is either
“no” or “not applicable,” check here
(NO).
If the answer to any of the above questions under OTHER INTERESTS is “yes,”
(YES), and briefly describe the circumstances on the last page of this
check here
form.

3. ADDITIONAL INFORMATION. If there are relevant aspects of your background or present
circumstances not addressed above that might reasonably be construed by others as affecting
your judgment in matters within the assigned task of the peer review you have been invited to
undertake, and therefore might constitute an actual or potential source of bias, please describe
them briefly.

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EXPLANATION OF “YES” RESPONSES:

During your period of service in connection with the activity for which this form is being
completed, any changes in the information reported, or any new information, which needs to be
reported, should be reported promptly by written or electronic communication to NOAA.

YOUR SIGNATURE

DATE

Reviewed by:
Name

Date

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