NIFA Application Kit

 

OMB Number: 0524-0039

Expiration Date: XX/XX/202X

CONFLICT OF INTEREST LIST
Name:
Instructions: Who completes this template: Each project director/principal investigator (PD/PI) or other person that the Request for Applications (RFA) specifies How this template is completed: List alphabetically – with last name first -- the full names of the following individuals: - All co-authors on publications within the past three years, including pending publications and submissions - All collaborators on projects within the past three years, including current and planned collaborations - All thesis or postdoctoral advisees/advisors - All persons in your field with whom you have had a consulting/financial arrangement/other conflict-of-interest in the past three years Indicate the person’s relationship to you (Co-Author, Collaborator, etc) with an “x”. Additional pages may be used as necessary. Note: Other individuals working in the applicant's specific area are not in conflict of interest with the applicant unless those individuals fall within one of the listed categories.
Name	Co-Author	Collaborator	Advisees/ Advisors	Other – Specify Nature

This file MUST be converted to PDF prior to attachment in the electronic application package.

Public reporting for collection of information is estimated to average XX minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to NIFA, OGFM, 2312 East Bannister Road, Mail Stop 10,000, Kansas City, MO 64131, Attention Policy Section. Do not return the completed form to this address. National Institute of Food and Agriculture US Department of Agriculture OMB No. 0524-0039 Form Approved For Use Through XX/XX/XXXX