D 1 - Conflict of Interest.pdf
PDF 58 KB Posted
- Solicitation number
- 36C24826Q0385
About this file
This is a Sample Conflict of Interest Acknowledgment form from the Veterans Health Administration (VHA) Handbook 1660.03, dated November 4, 2015. The form is designed to be completed by Chiefs of Staff, physicians, clinicians, researchers, allied health supervisors or managers, and any individual who assumes duties related to VA employment or participates in Healthcare-Related (HCR) Contracts. The acknowledgment requires the signatory to confirm receipt, reading, and agreement to abide by the guidance contained in VHA Handbook 1660.03 regarding conflicts of interest in contracts or agreements involving Healthcare-Related matters. Signatories must also verify that they have completed appropriate Tier Level Medical Sharing/Affiliate Office Customer training commensurate with their position and acknowledge awareness that the form may be placed in their Electronic Official Personnel File and in official procurement files for any HCR Contracts in which they are involved. The form includes signature and date fields for execution.
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 .