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[DOC File]ACCME Sample Disclosure Form
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Relevant financial relationships . ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity. ACCME has not set a minimal dollar amount for relationships to be significant.

[DOC File]Significant Financial Interest Disclosure ~ Guidelines
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to update this disclosure during the pendency of the award, either on an annual basis, or as new reportable significant financial interests are obtained; to cooperate in the development of a Memorandum of Understanding (MOU) that constitutes a conflict of interest “resolution plan;”

[DOC File]Sworn Statement of Assets, Liabilities, and Net Worth ...
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Sworn Statement of Assets, Liabilities, and Net Worth, Disclosure of Business Interests and Financial Connections Author: COA Last modified by: COA Created Date: 3/16/2007 1:56:00 AM Other titles: Sworn Statement of Assets, Liabilities, and Net Worth, Disclosure of Business Interests and Financial Connections

[DOCX File]Medicaid Provider Disclosure Statement
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Medicaid Provider Disclosure Statement. Completion and submission of this form is a federal and state requirement and a condition of participation in Medicaid reimbursement (see instructions for specific citations). Full and accurate disclosure of ownership as well as financial, managerial, and controlling interests is required.

STATEMENT OF DISCLOSURE OF INTERESTS
Section 18-54(a) SHELBY COUNTY GOVERNMENT. STATEMENT OF DISCLOSURE OF INTERESTS . INSTRUCTIONS: This form is for any official, employee, or appointee who approves requests for proposals or bid solicitations, or selects, evaluates, or recommends for award or rejection any bid or request for proposal response, for the purchase of personal property, goods, or services, including construction ...

[DOCX File]Fact Sheet: Disclosure of Interest
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the School Board Chairperson must provide a statement of any disclosure of interest by any school board member in relation to the school board during the financial year to the Director-General within 14 days of the end of the financial year.

[DOC File]NEBRASKA
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This statement must cover all financial interests for the entire "preceding calendar year" and not just as of year-end. If you have left office, this statement must cover all financial interests from the end of the calendar year for which you previously filed up to and including the date you left office. This statement covers the

[DOCX File]DISCLOSURE BY STATE EMPLOYEE OF FINANCIAL INTEREST IN A ...
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STATEMENT #1: I had one of the following financial interests in a contract made by a state agency before I was elected to my compensated state employee position. I will continue to have this financial interest in a state contract. OR ___ STATEMENT #2: I will have a new financial interest in a contract made by a state agency. My f

Conflict of Interest Template
Public disclosure of relevant significant financial interests including disclosure to the Steering Committee. In some cases, disclosure alone may be sufficient and no further action is needed. Disclosure should be noted in meeting minutes and may be required in Study publications.

STATEMENT OF DISCLOSURE OF INTERESTS
Section 18-54(b)(2) SHELBY COUNTY GOVERNMENT. STATEMENT OF DISCLOSURE OF INTERESTS . NOT-FOR-PROFIT CORPORATION. INSTRUCTIONS: This form is for any appointee of Shelby County who is a voluntary board member of a not-for-profit corporation and shall be submitted on or before February 15th annually.

FA-4139V: Financial Disclosure Statement
FA-4139V, 11/19 Financial Disclosure Statement§767.127, Wisconsin Statutes. This form shall not be modified. It may be supplemented with additional material. Page 7 of 7. FA-4139V, 11/19 Financial Disclosure Statement§767.127, Wisconsin Statutes. This form shall not be modified. It may be supplemented with additional material. Page 1 of 7

[DOCX File]Financial Disclosures and Conflicts of Interest
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The requirement of disclosure of financial interests and conflicts of interest is a continuing obligation. If circumstances change and the disclosure is no longer accurate, then disclosing entities must provide an updated form. Separate forms are required for the vendor, any parent entity(ies) and any subcontractors.

The City of Frederick, MD - Official Website | Official ...
This Financial Disclosure Statement describes all interests and related transactions and matters required to be disclosed by the City of Frederick Ethics Ordinance, Section 21-5 of the City Code with respect to the period indicated and pertaining to the person filing the statement.

Disclosure statement of financial interests