A Questionnaire refers to the information requested on the COI Disclosure Form from an individual disclosing potential conflicts. Individuals are asked a series of questions related to types of relationships to 3rd parties that may constitute a conflict. Individuals must identify the specific relationship(s) and details of those relationships when they indicate they have a type of COI relationship. The questions can vary by COI Relationship Type.
When an individual indicates a COI relationship, they are prompted to provide at least one record of relationship details but can enter multiple records. The following are examples, but not all-inclusive:
| COI Relationship | Questions | Answers |
|---|---|---|
| 1. Did you receive nonprofit (NIH, AHA) or University grant(s)? | Grantor | |
| Type of Grant | ||
| Scope of Grant | ||
| Financial Amount ($) | ||
| Start Date | ||
| End Date | ||
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| 2. Did you receive royalties or in-kind benefits (e.g. travel, accommodations) from a commercial interest? | Nature of Payment (honorarium, travel) | |
| Name of company/commercial interest | ||
| Financial Amount ($) | ||
| Date |
The following functionality is available from the Questionnaires group item: