PHS-6315 Assurance of Compliance by Sub-Award Recipients

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Form Approved: OMB No. 0937-0198;

Public Health Service

Expires:
See Statement of Burden Below

ASSURANCE OF COMPLIANCE
BY SUB-AWARD RECIPIENTS

INSTITUTIONAL OFFICIAL’S NAME

Regarding Procedures for Dealing With and
Reporting Research Misconduct Allegations

INSTITUTIONAL OFFICIAL’S TITLE

Please make any mailing changes in the space to the right:

NAME OF INSTITUTION
MAILING ADDRESS OF INSTITUTIONAL OFFICIAL

Place mailing label here.

NAME OF INSTITUTION FROM WHICH PHS FUNDS ARE RECEIVED AS SUBRECIPIENT

SECTION I. ORI ASSURANCE OF COMPLIANCE FOR SUB-AWARD RECIPIENTS
Institutions with U.S. Public Health Service (PHS) supported biomedical or behavioral research, research training or activities related to
that research or research training must provide PHS with an assurance of compliance with the Public Health Service Policies on Research
Misconduct, 42 C.F.R. Part 93.

SECTION II. CERTIFICATION
I certify that:
•

This institution has written policies and procedures in compliance with 42 C.F.R. Part 93 for inquiring into and investigating allegations of
research misconduct; and

•

This institution is in compliance with its own policies and procedures and the requirements of 42 C.F.R. Part 93.

•

The person responsible for administering the institution’s procedures, compliant with 42 CFR 93.300(b) is? (At some Institutions this person
is called the Research Integrity Officer or RIO).
Name of Official:

•

Title:

The person responsible for “fostering a research environment that promotes the responsible conduct of research” in compliance with 42
CFR 93.300(c) is?
Name of Official:

Title:

OFFICIAL CERTIFYING FOR INSTITUTION
NAME OF OFFICIAL (Please type)

TITLE

SIGNATURE
TELEPHONE NUMBER

DATE (mm/dd/yyyy)
FAX NUMBER

E-MAIL ADDRESS OF OFFICIAL:

(continued on next page)

PHS-6315 (Rev. 02/23)

Page 1 of 2

PSC Publishing Services (301) 443-6740

EF

STATEMENT OF BURDEN
Public reporting burden for this collection of information is estimated to
average 5 minutes to complete the form, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to:
OS Reports Clearance Officer, Hubert H. Humphrey Building, Room 503-H,
200 Independence Avenue, S.W., Washington, D.C. 20201 (Attn: PRA)
and to: Office of Management and Budget, Paperwork Reduction Project
(0937-0198) Washington, D.C. 20502. Please do not return this form to
either of these addresses.

PHS-6315 (Rev. 02/23)

Page 2 of 2

RETURN THIS FORM TO:
Robin Parker
Assurance Program
Office of Research Integrity
1101 Wootton Parkway, Suite 240
Rockville, MD 20852
Phone: (240) 453-8407
E-Mail: [email protected]

PSC Publishing Services (301) 443-6740

EF