D 1 - Conflict of Interest.pdf
PDF 58 KB Posted
- Attached to
- Q522--FY26: Teleradiology | West Palm Beach
- Solicitation number
- 36C24826Q0307
About this file
This is a Sample Conflict of Interest Acknowledgment form from the Veterans Health Administration (VHA) Handbook 1660.03, Appendix A, dated November 4, 2015.
The form is a template to be completed by each Chief of Staff, physician, clinician, researcher, allied health supervisor or manager, and any individual who assumes these duties in the future or participates in VHA Healthcare Related (HCR) Contracts. Signatories must acknowledge receipt, reading, and agreement to abide by the guidance contained in VHA Handbook 1660.03 regarding conflicts of interest in contracts or agreements for sharing of HCR. Individuals completing the form must confirm they have received appropriate Tier Level Medical Sharing/Affiliate Office Customer training commensurate with their position and must acknowledge that the acknowledgment may be placed in their Electronic Official Personnel File and that a copy will be filed in the official procurement file of any HCR Contracts in which they are involved. The form requires a signature and date from the employee.
View the file
Other files
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
� ��������������� ��!��" �!#��"���#�$��#��!���% ��&���#��'()*+,-*./()0�12.)�3-4(/567897:7(*�;/+:�.)�*/�<7�-/:=67*78�<>�73-2�?2.7;�/;�@*3;;A�=2>).-.3(A�-6.(.-.3(A�+7)73+-27+�3(8�366.78�2736*2�),=7+B.)/+�/+�:3(397+A�3(8�3(>�.(8.B.8,36�52/�3)),:7)�*27)7�8,*.7)�.(�*27�;,*,+7�/+�3(>�CD�7:=6/>77�52/�=3+*.-.=3*7)�.(�E?F�?/(*+3-*)G�HIJKLMNOMPQ�PR�SITUMLIVIQOW�XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX����YZ�����[�\��] ���Z]�Ẑ]�Z_����̀��Z�\]���a�̀Y��_b\]Ẑ[��[�̂ Z̀\̂�]�\̂���̀��Ẑc���Zd̀Y��]�\̂\c̀�Z̀\�̂�e���f��Ẑ]���g� �������Zc�\̀�h��̀Z\̂c�̀��[�̂id\[̀c��i�\̂ �̀��c̀�\̂�[�̂ �̀Z[̀c����Z_�����̂ c̀�i���cYZ�\̂_��i��!$���j�klmI�OlnIQ�OkI�lNNLPNLMlOI�oMIL�pImIq�rIsMKlq�tklLMQuvwRRMqMlOI�xRRMKI�yUJOPVIL�OLlMQMQu�KPVVIQJULlOI�zMOk�V{�NPJMOMPQ|��}~w�rtx�yUJOPVIL�SIJPULKI�yIQOIL�j�UQsILJOlQs�OklO�OkMJ�lKnQPzqIsuIVIQO�Vl{��I�NqlKIs�MQ�V{��qIKOLPQMK�xRRMKMlq��ILJPQQIq��MqI�lQs�OklO�l�KPN{�zMqq��I�NqlKIs�MQ�OkI�PRRMKMlq�NLPKULIVIQO�RMqI�PR�lQ{�~yS�yPQOLlKOJ�MQ�zkMKk�j�lV�MQmPqmIs|�������������������������������������������������������� ���������������tMuQlOULI�� � ��HlOI���
File details come from the government source that posted it. Updated .