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Conflict Of Interest Declaration Form for the United States

Conflict Of Interest Declaration Form Template for United States

A Conflict of Interest Declaration Form is a legal document used in the United States to disclose and document potential conflicts between an individual's professional duties and personal interests. This document complies with federal and state ethics laws, including the Ethics in Government Act and various state-specific requirements. It serves as a formal record of potential conflicts and demonstrates compliance with organizational policies and regulatory requirements.

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What is a Conflict Of Interest Declaration Form?

The Conflict of Interest Declaration Form is a critical compliance tool used across various sectors in the United States. It enables organizations to identify, document, and manage potential conflicts of interest that could compromise professional judgment or create unfair advantages. The form typically requires individuals to disclose financial interests, outside activities, personal relationships, and other situations that might conflict with their professional responsibilities. This declaration helps organizations maintain transparency, protect stakeholder interests, and comply with federal and state regulations.

What sections should be included in a Conflict Of Interest Declaration Form?

1. Personal Information: Declarant's name, position, department, and contact information

2. Declaration Statement: Formal statement acknowledging understanding of conflict of interest policies

3. Disclosure Areas: Specific areas requiring disclosure (financial interests, outside activities, relationships)

4. Certification: Signed statement confirming accuracy and completeness of disclosures

What sections are optional to include in a Conflict Of Interest Declaration Form?

1. Specific Industry Disclosures: Additional disclosures required for specific industries (healthcare, finance, etc.)

2. Research Conflicts: Specific disclosures related to research activities and academic institutions

3. Government Contracts: Specific disclosures related to government contracting activities

What schedules should be included in a Conflict Of Interest Declaration Form?

1. Definitions Schedule: Detailed definitions of terms used in the declaration form

2. Policy Reference: Organization's complete conflict of interest policy

3. Disclosure Guidelines: Detailed guidelines for completing specific sections of the form

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓÆµ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Jurisdiction

United States

Document Type

Declaration Form

Cost

Free to use
Clauses

























Industries

Ethics in Government Act 1978: Federal law establishing ethical standards for government officers and employees, including financial disclosure requirements and post-employment restrictions

Federal Conflict of Interest Statutes: 18 U.S.C. ยงยง 201-209 covering criminal conflict of interest statutes governing federal employees' conduct

STOCK Act 2012: Stop Trading on Congressional Knowledge Act prohibiting insider trading by government officials and requiring transparent financial disclosures

Foreign Corrupt Practices Act: Federal law prohibiting U.S. companies and individuals from bribing foreign officials to benefit their business interests

State Ethics Laws: State-specific legislation governing ethical conduct, disclosure requirements, and penalties for violations within each state's jurisdiction

Sarbanes-Oxley Act: Federal law establishing enhanced standards for corporate governance and financial disclosure, particularly for public companies

Dodd-Frank Act: Comprehensive financial reform legislation including provisions for corporate governance and conflict of interest disclosure

Stark Law: Healthcare-specific legislation prohibiting physician self-referral for Medicare and Medicaid patients

SEC Regulations: Securities and Exchange Commission rules governing disclosure requirements and conflicts of interest in financial institutions

FDA Regulations: Food and Drug Administration requirements regarding conflicts of interest in healthcare and pharmaceutical industries

Federal Acquisition Regulations: Regulations governing procurement by federal agencies, including conflict of interest provisions for government contractors

Fair Labor Standards Act: Federal law establishing employment standards including provisions that may relate to conflict of interest situations

Whistleblower Protection Laws: Federal and state laws protecting employees who report conflicts of interest and other ethical violations

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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