Cover letter 1

Manuscript Registration Form for Initial Submission to Health Evaluation and Promotion
A cover letter must accompany the manuscript and include the following.
(This form can be copied and used as a convenient cover letter to be attached to the manuscript you submit)
1. Title of the manuscript (A concise but complete and informative title of the article. Chemical formulas or abbreviations should not be used,
but long common terms can be abbreviated.)

2. Brief running title

3. Key words

4. Category of your manuscript: please check
Original article □, Review □, Case report □, Opinion □, Commentary □, Reference □, Educational seminar □, Technical report □,Survey report □, Letters to the editor □, Proceeding □, Brief report □, Field report □, Others □ (5. Word count :).

words

Full name without academic degree

Affiliation

Department, divisionReg. No. of JHEP member

Address 1 〒Address 2 〒Address 3
7. Personal information on co-authors
Full names without academic degrees

Affiliation

Department, division

JHEP member

Reg. No.(if yes)Yes ̲̲ No ̲̲
8. Submission of reviews, correspondence to the editor.
please make use of the space below.

9. English proofreading

e editor,

proofreader’s sign below.

Signature ＿＿＿＿＿＿＿＿＿＿＿＿＿＿ Date signed ＿＿＿＿＿＿ ／ ＿＿＿＿ ／ ＿＿＿＿
10. Advance publication
After manuscripts are accepted, HEP carries out advance publication of the manuscripts on J-STAGE. If you do not wish for advance publicationof your article, please check the box below.
�I do not want advance publication of my article on J-STAGE.

Cover letter 2

Authors’ responsibility, �nancial disclosure, assignment of copyright and acknowledgement
Title of manuscript

1. Authorship criteria and responsibilityI certify that: I have participated in the conception and design of this work or the analysisi and interprtation of the data as well as writing of themanuscript, to take the public responsibility for it; I have reviewed the manuscript and approve it for publication; neither this manuscript nor one��������������������������������������������������������������������������������������������������������������������������������������������������attachment.
2. Copyright
I transfer or otherwise convey all copyright to ownership to Japan Society of Health Evaluation and Promotion in the event that such work is
published by Japan Society of Health Evaluation and Promotion.
3. Financial disclosure
I certify that any af�liation with or �nancial involvement in any organization or entity with a direct �nancial interest in the subject matterdiscussed in the manuscript are disclosed below. Any �nancial project support of this research is identi�ed in an acknowledgement in themanuscript.
First author’s name (print)

First author’s signature

Date signed������������’ name(s) (print)������������’ signature(s)Date(s) signed

4. Acknowledgement
All persons who have made substantial contributions to the work reported in the manuscript, but who are not authors, are named in theAcknowledgement and have given me their written permission to be named.
����������������������������������������������������������������������������������������������������������������Corresponding author’s name (print)

Signature

Date signed

Cover letter 3

The Japan Society of Health Evaluation and Promotion:
Sell reported Potential Conflict of Interest Disclosure Statement
Author’s name:
Manuscript Title: (All authors are required to disclose any COI within the period of 36 months prior to the submission of any manuscriptin the subject matter of which any company,entity, or organization has as interest)

Area

If Yes, list the name(s) of author(s) andcommercial entity(ies)Yes or No

1. Employment/Leadership position/Advisory role
1,000,000 yen or more annually from one commercial
entityYes / No

2. Stock ownership or options
Profit of 1,000,000 yen or more annually from the stockof one company/ownership of 5% or more of total
shares of one company

Yes / No

3. Patent royalties/licensing fees
1,000,000 yen or more per one royalty/licensing fee
annually

Yes / No

4. Honoraria (e.g. lecture fees)
500,000 yen or more annually from one commercial
entityYes / No

5. Manuscript fees
500,000 yen or more annually from one commercial
entityYes / No

6. Research funding
1,000,000 yen or more annual payment to departments(department, field, or laboratory) who share researchexpenses from the same commercial entity.

Yes / No

7. Subsidies or Donations
1,000,000 yen or more annual payment to departments(department, field, or laboratory) who share researchexpenses from the same commercial entity.

Yes / No

8. Courses endowed by companies, etc.
1,000,000 yen or more total annual endowment by acompany, etc. for a course you belong toYes / No

9. Travel fees, gifts, and others

50,000 yen or more annually from one commercialentity

Yes / No

Date of Completion/Corresponding author’s signature /