May 15, 1996
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[This Executive Order supercedes the Executive Order "Independent Review Committee" of July 7, 1986.]
(Links to the Instructions, the Form / Format.)
The required disclosure of certain personal financial interests is provided for in 45CFR50.604 and 45CFR680, and in the CSU Conflict of Interest Code which is incorporated as Article 20 of Subchapter 7, Chapter 1, Part V of Title 5 of the California Code of Regulations, as approved by the California Fair Political Practices Commission and The Office of Administrative Law, State of California.
This CSULB Presidential Executive Order is issued in accordance with and to augment the policies of the Federal and State governments concerning the disclosure of private financial interests which could reasonably appear to constitute a conflict of interest when public funds are spent in the conduct of extramurally funded research, and, equally, with the overall objective of promoting objectivity in research and development activities.
As a fundamental consideration, the resources of this University shall not be diverted to exclusive, inappropriate, or disproportionate private interests and, equally, private interests shall not determine the priorities of allocation of University resources.
Employees of the University or of the University Foundation applying for external funding from the Federal government, or from agencies as required by the California Fair Political Practices Act (Brown Act), who decline to provide the requisite disclosure of financial interests or who submit false or incomplete disclosures may be subject to disciplinary action, in accordance with the applicable Memorandum of Understanding, CSU regulations governing their employment, and the State Education Code.
In no case shall the University or the University Foundation accept funds from an external agency on behalf of an employee or project in the absence of a complete disclosure and satisfactory completion of actions required by the provisions of public law and this Order to manage, reduce, or eliminate conflicts of interest.
This Order re-establishes the University Independent Review Committee. The Committee shall be composed of:
Each member of the Committee is to be familiar with the State and Federal regulations governing conflicts of interest.
The Committee shall review all statements regarding potential conflicts of interest submitted thereto by the Director, Office of University Research, or discovered in connection with its own periodic reviews of the official logs of proposals sent to external funding agencies.
When the Committee believes a "significant" conflict of interest exists under either the State and Federal regulations then in effect, it shall:
The Director, Office of University Research is charged with responsibility
Effective: Immediately
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Robert C. Maxson, President
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This Order shall be made available on request in the Office of University Research and Published on the Campus-Wide Information System.
CSULB Presidential Executive Order "Conflicts of Interest in Grants and Contracts" (5-15-96) requires that, before any application for funds from a federal or other covered external agency may be forwarded to that agency, applicants must indicate by their signature on the Internal Clearance form (Page 2, Item 13.) that they have read these instructions. If, having reviewed the criteria (set forth below), applicants believe they have financial interests exceeding the indicated amounts under the specified conditions, they must complete either (1) a CSULB Federal Disclosure of Financial Interests Form or (2) a California Form 700-U, as appropriate. These forms are available in the Office of University Research, University Foundation, and college offices.
This requirement applies to any grant or contract application where it is proposed that award funds will be held in the University, the University Foundation, or that the name or any University resources will be involved. Completed Internal Clearance Forms and Disclosure forms must be presented to the Director, Office of University Research.
The CSULB Federal Disclosure of Financial Interest Form shall be used for all applications to all levels of government, including municipal, county, state, other state, federal, other national, and international governmental organizations, unless it can be shown that no Federal funds are involved. Such evidence must be documented and produced by the applicant.
Disclosures of financial interest will be reviewed by the Director, Office of University Research and, when there is an economic interest disclosed that may pose a conflict of interest or the appearance of a conflict of interest, the Director will refer the materials to the Independent Review Committee of the University for review. All disclosures will be kept on file in the Office of University Research.
If the Committee believes that a "significant" conflict of interest may exist under the relevant definitions, the person who has disclosed the information, the funding agency applied to (if so required by regulation or law), and the Provost will be so informed. The employee will be referred to an appropriate office of the University or University Foundation to determine whether the conflict can be appropriately managed, reduced, or eliminated.
Mitigation to the satisfaction of the University and the funding agency must be accomplished prior to the acceptance of any funds, whether the application is for a new project, a competing or non-competing continuation of a project, or an amendment to the budget of an existing project in those cases in which the Federal government requires new disclosures.
Exempted from disclosure are: your regular salary, royalties or other remuneration from the University (or auxiliaries); salary, royalties or other payments from other sources that, when aggregated for yourself, your spouse, and your dependent children over the next twelve months are not expected to exceed $10,000; income from seminars, lectures, or teaching engagements sponsored by public or non-profit entities;
Therefore, conditioned by the definitions and exceptions above, LIST all of:
| Name: |
| Campus Address: |
| Campus Telephone: |
| Email: |
| Home Address: |
| Home Telephone: |
| Title of the project for which you are applying for external funds: |
Circle Yes or No
| Agency to which you are applying: |
| Name of your principal contact there: |
| That person's telephone number: |
| E-mail: |
| Amount applied for: |
| Over the period: |
Significant Financial Interests: (Please respond by listing financial interests on additional numbered page(s) inserted after the following instructions.
Do NOT list: your regular salary, royalties or other remuneration from the University (or auxiliaries); salary, royalties or other payments from other sources that, when aggregated for yourself, your spouse, and your dependent children over the next twelve months are not expected to exceed $10,000; income from seminars, lectures, or teaching engagements sponsored by public or non-profit entities;
In determining whether to disclose an interest, please understand that the CSULB Independent Review Committee is charged with responsibility for determining whether or not any particular interest constitutes a potential conflict. Thus, you should at least mention any interest about which you are uncertain.
Complete your disclosure with the following:
"I declare under the penalty of perjury under the laws of the State of California that I have used all reasonable diligence in preparing this Disclosure and that, to the best of my knowledge, it is true and complete.
| Signature: |
| Date: |