**National Oceanic and Atmospheric Administration**

**CONFLICT OF INTEREST DISCLOSURE**

**For General Scientific and Technical Studies and Assistance**

NAME: TELEPHONE:

ADDRESS:

EMAIL ADDRESS:

CURRENT EMPLOYER:

PEER REVIEW SUBJECT:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[INSTRUCTIONS]{.underline}

**Please complete this form, sign and date it on the last page, attach a
copy of your curriculum vitae, and return the form to the NOAA Office
coordinating the peer review process. Retain a copy for your records.**

It is essential that peer reviewers of NOAA influential scientific
information or highly influential scientific assessments not be
compromised by any significant conflict of interest. For this purpose,
**the term \"conflict of interest\" means any financial or other
interest which conflicts with the service of the individual because it
(1) could significantly impair the individual\'s objectivity or (2)
could create an unfair competitive advantage for any person or
organization.** Except for those situations in which NOAA determines
that a conflict of interest is unavoidable and promptly and publicly
discloses the conflict of interest, no individual can be appointed to
review information subject to the OMB Peer Review Bulletin if the
individual has a conflict of interest that is relevant to the functions
to be performed.

The term \"conflict of interest\" means something more than individual
bias. There must be an *interest,* ordinarily financial, that could be
directly affected by the work of the peer reviewers.

Conflict of interest requirements are objective and preventive*.* They
are not an assessment of one\'s actual behavior or character, one\'s
ability to act objectively despite the conflicting interest, or one\'s
relative insensitivity to particular dollar amounts of specific assets
because of one\'s personal wealth. Conflict of interest requirements are
objective standards designed to eliminate certain specific, potentially
compromising situations from arising, and thereby protect the
individual, other peer reviewers, NOAA, and the public interest. The
individual, the other peer reviewers, and NOAA should not be placed in a
situation where the findings and conclusions of

a review could be reasonably questioned, and perhaps discounted or
dismissed, simply because of the existence of conflicting interests.

The term \"conflict of interest\" applies only to *current interests*.
It does not apply to past interests that have expired, no longer exist,
and cannot reasonably affect current behavior. Nor does it apply to
possible interests that may arise in the future but do not currently
exist, because such future interests are inherently speculative and
uncertain. For example, a pending formal or informal application for a
particular job is a current interest, but the mere possibility that one
might apply for such a job in the future is [not]{.underline} a current
interest.

The term \"conflict of interest\" applies not only to the personal
interests of the individual but also to the *interests of others* with
whom the individual has substantial common financial interests if these
interests are relevant to the functions to be performed. Thus, in
assessing an individual\'s potential conflicts of interest,
consideration must be given not only to the interests of the individual
but also to the interests of the individual\'s spouse and minor
children, the individual\'s employer, the individual\'s business
partners, and others with whom the individual has substantial common
financial interests. Consideration must also be given to the interests
of those for whom one is acting in a fiduciary or similar capacity
(e.g., being an officer or director of a corporation, whether profit or
nonprofit, or serving as a trustee).

The overriding objective of the conflict of interest inquiry in each
case is to identify whether there are interests -- primarily financial
in nature -- that conflict with the individual's review because they
could impair the individual's objectivity or could create an unfair
competitive advantage for any person or organization. The fundamental
question in each case is does the individual, or others with whom the
individual has substantial common financial interests, have identifiable
interests that could be directly affected by the use of the peer
reviewer's findings and conclusions regarding the scientific information
being reviewed?

The application of these concepts to this review for potential conflicts
of interest must necessarily be addressed in each case on the basis of
the particular facts and circumstances involved. The questions set forth
below are designed to elicit information from you concerning possible
conflicts of interest that are relevant to the functions to be performed
in the course of the peer review in which you have been asked to serve.

1\. [FINANCIAL INTERESTS]{.underline}

\(a\) Taking into account stocks, bonds, and other financial instruments
and investments including partnerships (but excluding broadly
diversified mutual funds and any investment or financial interests
valued at less than \$10,000), do you or, to the best of your knowledge,
others with whom you have substantial common financial interests, have
financial investments that could be affected, either directly or by a
direct effect on the business enterprise or activities underlying the
investments, by the findings and conclusions that you would prepare as a
peer reviewer?

\(b\) Taking into account real estate and other tangible property
interests, as well as intellectual property (patents, copyrights, etc.)
interests, do you or, to the best of your knowledge, others with whom
you have substantial common financial interests, have property interests
that could be directly affected by the findings and conclusions that you
would prepare as a peer reviewer?

\(c\) Could your employment or self-employment (or the employment or
self-employment of your spouse), or the financial interests of your
employer or clients (or the financial interests of your spouse\'s
employer or clients) be directly affected by the findings and
conclusions that you would prepare as a peer reviewer?

\(d\) Taking into account research funding and other research support
(e.g., equipment, facilities, industry partnerships, research assistants
and other research personnel, etc.), could your current research funding
and support (or that of your close research colleagues and
collaborators) be directly affected by the findings and conclusions that
you would prepare as a peer reviewer?

1.  \(e\) Could your service as a peer reviewer create a specific
    financial or commercial competitive advantage for you or others with
    whom you have substantial common financial interests?

**If the answer to all of the above questions under FINANCIAL INTERESTS
is either "no" or "not applicable," check here (NO).**

**If the answer to any of the above questions under FINANCIAL INTERESTS
is "yes," check here (YES), and briefly describe the circumstances on
the last page of this form.**

2\. [OTHER INTERESTS]{.underline}

\(a\) Is the central purpose of the peer review for which this
disclosure form is being prepared a critical assessment and evaluation
of your own work or that of your employer?

\(b\) Do you have any existing professional obligations (e.g., as an
officer of a scientific or engineering society) that effectively require
you to publicly defend a previously established position on an issue
that is relevant to the scientific information that you have been
invited to review as a peer reviewer?

\(c\) To the best of your knowledge, will your participation in this
peer review enable you to obtain access to a competitor's or potential
competitor's confidential proprietary information?

\(d\) If you have ever been a U.S. Government employee (either civilian
or military), to the best of your knowledge, are there any federal
conflict of interest restrictions that may be applicable to your service
in connection with this review?

\(e\) Are you an employee of any sponsor or this project?

\(f\) If the peer review activity for which this form is being prepared
involves reviews of specific applications and proposals for contract,
grant, fellowship, etc. awards to be made by NOAA or other sponsors, do
you or others with whom you have substantial common financial interests,
or a familial or substantial professional relationship, have an interest
in receiving or being considered for awards that are currently the
subject of the review being conducted by this peer review?

\(g\) If the peer review activity for which this form is being prepared
involves developing requests for proposals, work statements, and/or
specifications, etc., are you interested in seeking an award under the
program for which the peer review on which you have been asked to serve
is developing the request for proposals, work statement, and/or
specifications -- or, are you employed in any capacity by, or do you
have a financial interest in or other economic relationship with, any
person or organization that to the best of your knowledge is interested
in seeking an award under this program?

**If the answer to all of the above questions under OTHER INTERESTS is
either "no" or "not applicable," check here (NO).**

**If the answer to any of the above questions under OTHER INTERESTS is
"yes," check here (YES), and briefly describe the circumstances on the
last page of this form.**

3\. ADDITIONAL INFORMATION. If there are relevant aspects of your
background or present circumstances not addressed above that might
reasonably be construed by others as affecting your judgment in matters
within the assigned task of the peer review you have been invited to
undertake, and therefore might constitute an actual or potential source
of bias, please describe them briefly.

[EXPLANATION OF "YES" RESPONSES:]{.underline}

*During your period of service in connection with the activity for which
this form is being completed, any changes in the information reported,
or any new information, which needs to be reported, should be reported
promptly by written or electronic communication to NOAA.*

YOUR SIGNATURE DATE

Reviewed by:

Name Date

***[Paperwork Reduction Act Statement:]{.underline}***

*Public reporting burden for this collection of information is estimated
to average 30 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other
suggestions for reducing this burden to Tom Gleason, NOAA Fisheries
Office of Management & Budget, 1315 East-West Highway, Silver Spring,
Maryland 20910.*

*Notwithstanding any other provisions of the law, no person is required
to respond to, nor shall any person be subjected to a penalty for
failure to comply with, a collection of information subject to the
requirements of the Paperwork Reduction Act, unless that collection of
information displays a currently valid OMB Control Number.*