Conflict of Interest Disclosure.docx
DOCX document 28 KB Posted
- Opportunity number
- DFOP0016985
About this file
This document is a Conflict of Interest Disclosure form that reviewers must complete when evaluating proposals submitted for a federal grant opportunity. The form requires the reviewer to disclose any potential conflicts of interest, such as being listed as staff on a proposal, having a close personal or financial relationship with the applicant, or having a collaborative relationship with the applicant outside of the reviewer's government work. If a reviewer identifies a conflict, they must provide the name of the applicant and proposal in conflict. If the reviewer does not have any conflicts, they must indicate this as well.
The federal grant opportunity this disclosure is associated with is the "Countering Proliferator State Advanced Conventional Weapons Proliferation" program, which is funded by the Department of State's Bureau of International Security and Nonproliferation under the Global Threat Reduction grant program (CFDA 19.033). The program aims to build foreign partner capacity to counter the malign impact of proliferator states' advanced conventional weapons sales, procurement, and proliferation networks.
C of I
View the file
Other files
Show all 25
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
U.S. Department of State
DISCLOSURE OF CONFLICT OF INTEREST
As a reviewer of applications submitted to [BUREAU], I find the following conflicts with proposals that I have received to review:
_____ I am listed as a staff member, consultant, or advisor on a proposal.
_____ I have close personal or familial relationship with the author or staff on a proposal.
_____ I have or recently (i.e., within last year) had a financial relationship with the author or staff on a proposal involving grants, publications, presentations, etc.
_____ I have or recently had a professional relationship with an applicant under review, including serving as an officer or having served as a past officer or as a member of the board of directors of the submitting organization.
_____ I am or recently been a faculty or staff member of a department, school, university, or organization submitting a proposal.
_____ I have or recently had collaborative relationship (outside of my USG work) with a proposal’s author or project staff.
____ I cannot review a proposal objectivity or I feel that others would view such action to be problematic.
Provide the name of the applicant and proposal in conflict: ______________________________
__________ I do not have a conflict with any of the proposals assigned to the panel on which I serve.
NAME (Print) _________________________________________
SIGNATURE __________________________________________ DATE __________
Panel Name/NOFO Title: ________________________________
Panel Dates: _________________________________________
File details come from the government source that posted it. Updated .