Health Services Research & Development (HSR&D)

Data and Safety Monitoring Board (DSMB) Charter
HSR&D DSMB Charter Version 1.1

TABLE OF CONTENTS

1. Introduction

2. Purpose and Responsibilities of the DSMB

3. Organizational Chart and Composition of Board

4. Conflicts of Interest

5. Monitoring 

6. Communications

7. Overview of Reviews, DSMB and PI Responsibilities

7.1 Briefing DSMB re Analysis Plan and Adverse Event Monitoring

7.2 Annual Progress Reports

Overview and Procedures

Content of the Annual Progress Report

DSMB Recommendations

7.3 Midyear Review
HSR&D DSMB Charter Version 1.1 3 

1. Introduction 

The requirement for data and safety monitoring of clinical trials is addressed in VHA 

Handbook 1200.5. The VA‟s policy on data and safety monitoring is consistent with that 

of the Department of Health and Human Services which states that: “The establishment 

of data and safety monitoring boards is required for multi-site clinical trials involving 

interventions that entail potential risk to the participants.” (NIH Policy for Data and 

Safety Monitoring, June 10, 1998).

The purpose of this manual is to describe practices and procedures for the organization 

and function of the Data and Safety Monitoring Board (DSMB or Board) to review 

Health Services Research & Development (HSR&D) multi-site intervention trials which 

include human participants.

This charter will be reviewed periodically and updated. All versioning and updates to 

this document will be recorded in Appendix A – Versioning, accessible at the end of this 

document and this bookmark when accessed electronically.

2. Purpose and Responsibilities of the DSMB

The Data and Safety Monitoring Board provides ongoing evaluation of studies‟ progress 

including patient accrual and retention, monitoring of adverse events, and the adequacy 

and efficiency of the analysis plan to discern outcomes that might require study 

modifications, or result in early cessation of the study due its benefits or harms. The 

DSMB does not evaluate the scientific merit or methodology of the study, nor does it

directly participate in the execution of a study‟s protocol, monitor the budget, or approve 

sub-protocols or other modifications to the study; these functions are performed by other 

committees within the HSR&D Service. The DSMB may review approved protocol 

modifications with substantive statistical and monitoring changes and request amended 

Data Analysis Plans (DAP) from the study principal investigator (PI) when necessary. 

The major responsibilities of the Board are:

To review the data analysis plan and make recommendations for additions or 

changes to the plan.

To assess the performance of each participating center and make appropriate 

recommendations regarding continuation, probationary status, or termination.

To consider patient accrual, overall study progress (timeline and follow-up 

participation), adverse effects and patient safety, treatment effectiveness/futility, 

and proper monitoring and reporting by the study team as these affect the ethical 

treatment of participants or the ethical conduct of research.

Report to the HSR&D Director and PI on any perceived problems with study 

conduct, enrollment, sample size, and data collection.
HSR&D DSMB Charter Version 1.1 4 

Provide the HSR&D Director and PI recommendations regarding continuation, 

termination or other modifications of the study based on evaluation of observed 

benefits or adverse effects of the intervention, as well as perceived likelihood of 

study efficacy based on patient accrual and retention.

3. Organizational Chart and Composition of Board

The Data and Safety Monitoring Board is an independent advisory group to the Director 

of HSR&D (Figure 1).

Figure 1: Organizational Chart

Director, HSR&D

Principle Investigator HSR&D DSMB

Multiple Study Sites Institutional Review Board(s)

Recommendations

The HSR&D Director appoints members of the DSMB. The DSMB members are highly 

qualified by background, training, experience, and knowledge in relevant disciplines (see 

Appendix B for a current roster). 

Regular Voting Members will include, at a minimum:

two HSR&D Researchers 

two Biostatisticians 

a Health Economist

a Physician

an expert in human research protection issues who has served on an 

Institutional Review Board
HSR&D DSMB Charter Version 1.1 5 

Subject matter representation for studies monitored by the board is not required. 

Members will serve three-year terms and may fulfill multiple roles. The terms will be 

staggered to provide partial change in membership as necessary. 

The HSR&D Director appoints the Chairperson of the DSMB. The responsibilities of the 

Chairperson include conducting meetings, assigning data analysis plans and reports to 

board members for review, conducting board deliberations associated with data analysis 

plans, mid-year and annual reports, and summarizing the deliberations of the Board. The 

Chairperson serves a three-year term with successive terms appointed at the discretion of 

the HSR&D Director. The first year of each term is a provisional period, at the end of 

which continuation to fulfillment or termination of term will be decided by the HSR&D 

Director.

Ex Officio Members: At the discretion of the HSR&D Director, non-voting participatory 

members may include the HSR&D DSMB Program Manager and Program Coordinator, 

selected HSR&D staff and investigators, and field-based administrative support. 

The HSR&D service pays the travel expenses for DSMB members and, when in-person 

meetings are required, for Principal Investigators designated to attend the meeting. NonVA DSMB consultants are paid an honorarium. Meetings of the DSMB are closed 

meetings so that additional attendees, such representatives for pharmaceutical companies 

and other vendors, may not attend meetings unless invited by the DSMB to clarify

specific issues.

4. Conflicts of Interest

Any real or perceived conflicts of interest (COI) of board members will be identified at 

the outset of each annual meeting. Board members who participated in the planning of a 

study, have a key role in a study, or have a reasonably anticipated conflict of interest will 

recuse themselves when that study is under review. Members with identified conflicts of 

interest will sign a COI form identifying their conflicts (template available in Appendix C

– COI Template, bookmark).

5. Monitoring 

The DSMB has the authority to monitor HSR&D multi-site, intervention trials involving 

human participants. The level of risk to study participants is a consideration in the 

Board‟s decision to monitor the study. The decision to monitor a study is ultimately the 

responsibility of the DSMB Chair. The degree of monitoring will be commensurate with 

the nature, size and complexity of the study, the risks associated with participation, and 

the vulnerability of the particular population from which the sample is drawn. All 

HSR&D multi-site intervention studies that entail potential risk to participants are 

reviewed annually by the DSMB. 

For the purpose of this charter, a multi-site intervention trial is defined as a study where 

an intervention occurs at two or more VA facilities covered by separate Federal Wide 
HSR&D DSMB Charter Version 1.1 6 

Assurances (FWA; see VHA Handbook 1058.03). These types of studies use a common 

protocol with central coordination but may seek multiple Institutional Review Board 

(IRB) approvals or a single IRB approval through the VA Central IRB.

DSMB review covers the period from study approval through completion of the final 

assessment of the last study participant. The DSMB monitoring period concludes after 

the final contact with study participants or after the final record assessment to determine 

whether further contact is required. 

6. Communications

Communications between the DSMB and a study PI will be conducted through the 

DSMB Program Manager and/or Coordinator. It is expected the study PI or team will not 

communicate about the study directly with the DSMB members or Chair unless solicited 

by the DSMB members, Chair, Program Manager or Coordinator, except when making 

presentations at scheduled meetings. 

7. Overview of Reviews, DSMB and PI Responsibilities

Within 30 days of notification of intent to fund, the PI is to submit a description of the 

data analysis and adverse events monitoring plans for the study using the Just-In-Time 

(JIT) document manager. Thereafter, each study submits an annual progress report due 

December 1 each year. Notifications of reminders for submission of annual reports will 

be sent before the due date; however, it is ultimately the responsibility of the PI to submit 

annual reports by December 1 each year. At the request of the DSMB, each study may be 

asked to submit a briefer mid-year report for review. Notification of due date and review 

date will be sent to the PI in advance of mid-year reviews. Each of these documents and 

processes are described in detail below.

7.1. Briefing the DSMB about the Data Analysis Plan and Adverse Event 

Monitoring

To aid the Board in fulfilling its responsibility of reviewing the data analysis plan and 

adverse event monitoring before initiating data collection, the Principal Investigator must 

submit a 3-7 page description of the data analysis plan (with appendices, if extensive 

detail is required for description), which also includes the plan to monitor adverse and 

serious adverse events during the study to HSR&D within 30 days after being notified of 

HSR&D‟s intent to fund the study. The Principal Investigator uploads the DAP to the JIT 

Document Manager as a single paginated PDF (include page number, PI, and date on

the footer of each page) with table of contents. 

The description of the data analysis plan should summarize all of the statistical analyses 

for the primary, and important secondary, hypotheses or research questions specified in 

the original proposal. While there may have been a data analysis plan included with the 

original proposal, the Principal Investigator should assure that the description includes a 

discussion of each of the following points applicable to the study:
HSR&D DSMB Charter Version 1.1 7 

DAP (Document should be named Doe_IIR00-000_DAP.pdf)

1. The rationale for the study sample size

2. A specific description of how the data will be collected

3. The method of randomization (describing any stratification and blocking 

techniques)

4. Plans for and specification of the purpose of any interim looks at the data (with 

regard to stopping rules for superiority, futility, or sample size re-estimation)

5. Methods for handling missing data points and subject dropouts

6. Definitions of covariates to be included in adjustment models

7. Methods for dealing with data transformations

8. Definitions of the analytical sets (i.e. intent-to-treat, per-protocol, and any other 

analytical subsets)

9. A list of adverse and serious adverse events to be monitored, how they will be 

defined, and a plan for prospectively tracking them

Items to include in a single file (pdf preferred) when submitting the DAP to the JIT 

(Document Manager, the document should be named Doe_IIR00-000_DAP_docs.pdf)

1. Table of Contents

2. Abstract 

3. Project narrative* 

4. Response to conditions, if applicable 

5. Gantt chart 

6. Draft consent forms 

*Project narrative is the body of the proposal submitted to SMRB, excluding all 

1313s (budget, personnel, etc). Please contact HSR&D if you have questions. 

Board members, and especially the biostatisticians on the Board, will review and 

comment on the character and definition of response variables, sample size, and plans for 

measurement, data collection, frequency of observations, data processing and analysis, as 

well as any other relevant study issues that may affect research integrity, the safe conduct 

of the study, or the welfare of participants.

7.2 Annual Progress Report and Meeting

Overview and Procedures

The DSMB meets during the second quarter each fiscal year, either face-to-face or by 

teleconference. The initial progress review will take place as scheduled by HSR&D staff. 

The Principal Investigator may be requested to participate in the review meeting by 

teleconference. However, at the discretion of the DSMB and in consultation with 

HSR&D Central Office, a Principal Investigator may be asked to attend the meeting in 

person. Annual reviews will be based on a progress report prepared by the Principal 

Investigator. The deadline for this report is December 1 each year of monitoring.

Principal Investigators will be reminded in advance of the due date; however, it is the 
HSR&D DSMB Charter Version 1.1 8 

responsibility of the PI to ensure annual reports are submitted by December 1 each year 

of monitoring.

At the meeting, the PI will be asked to make an opening statement not to exceed fifteen 

minutes. The statement should include the background of the study, a brief summary of 

the study design, the participant recruitment and retention record, patient safety issues, 

and any interim monitoring. In making the opening statement, the PI may make 

reference to material in the study‟s progress report, but there will be no access to audiovisual equipment. Handouts should be kept to a minimum. If the PI is not attending the 

meeting and has not selected an alternate study team member for representation, a Board 

member assigned to review the report will give a brief overview. Board members with 

declared conflicts of interest will recuse themselves from discussions and voting during 

reviews of identified studies.

After the overview, the project will be discussed among the DSMB members and the PI

(if present) to focus on questions based on the written progress report that the DSMB has 

been able to review prior to the meeting. Board reviewers are asked to comment on the 

recruitment and retention strategies and performance, study progress, the data analysis 

plan, and any other pertinent features of the report. The biostatistician reviewer is asked 

to comment also on the character and definition of response variables, measurement, data 

collection, frequency of observations, sample size, progress on data processing and 

analysis, and any other relevant features that affect the protection of participants across 

all study sites or challenge the potential validity or merit of the study. It would be 

unethical to continue enrolling participants in a study that could not generate knowledge.

After the discussion, the PI will be excused for the DSMB Executive Session. The 

HSR&D and program representatives will remain as non-voting members. This

Executive Session will include consideration of a formal motion to continue the study, 

the language of the DSMB report to IRBs when applicable, and any recommendations for 

changes in the conduct of the study.

Content of the Annual Progress Report 

For the annual review of multi-site HSR&D studies, whether in-person or by 

teleconference, the PI will be responsible for uploading the progress report to 

http://art.puget-sound.med.va.gov/ChooseProject.cfm as a single paginated PDF 

(include page number, PI, and date on each page) with table of contents in the 

following format:

1. Table of Contents.

2. Principal Investigator‟s Summary of Progress Cover Letter. The Principal 

Investigator shall prepare a short letter (maximum 5 pages) addressed to the 

DSMB covering study progress and performance. This letter should include a 

history of the study to date, including current study stage (pre-initiation of 

recruitment, recruitment and follow-up, follow-up only, post-data collection 
HSR&D DSMB Charter Version 1.1 9 

analysis only) and a statement of the current status. The latter includes the 

number of participants (usually patients but could also include caregivers or 

providers) entered into the study and a comparison with the projected number; 

losses to the study and a statement of when and why these occurred; 

comparison of recruitment results to date with study objectives; and estimates 

of the prospects of success.

3. Executive Summary or Abstract of the Study.

4. A GANTT chart (by specific calendar year or specific fiscal year).

5. A chronology of major events that have occurred (e.g. start of funding, start 

of patient recruitment, study meetings, changes in participating sites, 

important protocol changes, scheduled end of funding).

6. Consolidated Standards for Reporting of Trials (CONSORT) diagram

(http://www.consort-statement.org/consort-statement/flow-diagram0/).

7. Tabular material: Each table or set of tables should be interspersed with 

narrative sections. All tables should be submitted as described. These 

narrative summaries should point out salient features and emphasize areas of 

special interest. They should serve the reader as a „road map‟ guide to the 

tables. The tables should present data on the following areas:

a. Enrollment – number of patients entered into the study (by time and site) 

in comparison with the projected number. Graphs comparing actual 

recruitment with projected recruitment over time, overall and by site, are 

suggested.

b. Baseline comparison with control versus intervention of relevant 

characteristics of study groups

c. Recruitment and retention flow diagram (http://jama.amaassn.org/misc/ifora.dtl#CONSORTFlowDiagramandChecklist)

d. Patient Retention– deaths, losses to follow-up, withdrawals, etc., by site 

and blinded study group

e. Patient Safety – The report should elaborate adverse and serious adverse 

events including tables of adverse events and serious adverse events by 

group, with the groups identified solely as Group A, Group B, etc. The 

report should include a 2 X 2 table for each site with intervention and 

control groups and with adverse events and serious adverse events. The 

report should also include a listing of all deaths and hospitalizations.

i. Adverse Event (AE)–Any unfavorable and unintended sign, 

symptom, or disease temporally associated with the use of a 

medical product, procedure or other therapy, or in 

conjunction with a research study whether or not considered 

related to the product, procedure, or other therapy, or study .
HSR&D DSMB Charter Version 1.1 10 

ii. Serious Adverse Event (SAE)–An assessment based on 

subject/event outcome, or required intervention, of whether one 

or more adverse event occurrences pose a threat to a study 

participant‟s life or functioning. This includes:

Death - Any life-threatening experience

Any event which requires or prolongs a hospital stay 

A persistent or significant disability/incapacity 

A congenital anomaly/birth defect

An event that may not be immediately life-threatening or 

result in death or hospitalization but may jeopardize the 

patient, or may require intervention to prevent one of the 

other outcomes.

iii.Categorization of AEs and SAEs–Each AE and SAE should be 

evaluated as to whether it was expected or unexpected, and the 

likelihood that the AE or SAE was related to participation in the 

study.

iv.Expected/Unexpected—an assessment of whether the adverse 

event commonly occurs as part of the clinical condition and is 

consistent with the applicable study documentation (e.g., 

investigator‟s brochure, protocol document, or consent 

document) or product labeling (package insert). 

v. Relationship to Participation in the Study—an assessment of 

the degree to which it is reasonable to make a causal connection 

between the AE or SAE and participation in the study.

Patient safety includes safeguarding the rights and welfare of 

subjects of research, and reporting unanticipated problems 

involving risk to subjects or others. The risks include events that 

(1) are not expected given the nature of the research procedures 

and the subject population being studied; and (2) suggest that 

the study places subjects or others at a greater risk of harm or 

discomfort related to the research than was previously known or 

recognized. Unanticipated problems that involve risk to study 

subjects or others may be physical, mental, emotional, 

economic, or involve privacy. When appropriate, unanticipated 

problems should be included in the report. 

f. Effectiveness–When appropriate, the DSMB may request a comparison of 

the overall outcome and event rates with the rates predicted in the original 
HSR&D DSMB Charter Version 1.1 11 

proposal in order to determine if a study warrants early cessation due to its 

benefits or harms. 

Reports should include only aggregated data; however, the DSMB may 

request blinded or unblinded data. To prevent the Principal Investigator 

from being influenced by the interim results, if requested, these sections 

should be completed by the Study Biostatistician and mailed to the 

HSR&D_DSMB@va.gov separately, utilizing PKI when sending 

identifiable data.

g. Reconsideration of the power/sample size issues may be necessary. In the 

case of a request to VACO for extension of patient intake or follow-up 

duration, the report to DSMB should also contain a summary of the 

justification for the request. When investigators request an extension or if 

there is any problem with the conduct of the trial, the calculation of 

conditional power must be provided to the DSMB. 

8. Appendices 

a. Previous DSMB feedback reports, if any. The DSMB feedback report is 

generated to reflect the DSMB review and approval of the study to 

continue, and it is signed by the DSMB Chairperson.

b. (Possibly updated) 25 page narrative section from the approved proposal 

together with any post-approval updates. (Do not include entire proposal.)

c. Approved current versions of Informed Consent Form(s)

d. Other supplemental material and additional information not included in 

cover letter. (optional)

Once HSR&D ART (http://art.puget-sound.med.va.gov/ChooseProject.cfm) receives the 

report, it is reviewed to ensure that all the required information is included. 

DSMB Recommendations

Generally one of four actions is taken:

Unconditional approval. The study is approved to continue.

Conditional approval. The Board approves the study to continue, but 

approval is contingent on specific recommended modifications. 

Close the study. The Board recommends that the study be terminated.

Exempt from monitoring. 

Principal Investigators who attend the meeting in-person will be informed of the DSMB 

recommendation(s) immediately after the Executive Session; those attending by 

teleconference will have an opportunity to be informed of the DSMB recommendation(s) 

within 10 working days of the close of the DSMB meeting. The recommendation is 

forwarded to the HSR&D Director, who will issue a formal report to each PI.
HSR&D DSMB Charter Version 1.1 12 

In addition to chairing each meeting, the Chairperson of the DSMB will be responsible to 

finalize a brief feedback report of each study review session. The feedback report states 

those actions that the Board believes are necessary or highly desirable. These are phrased 

as recommendations to the HSR&D Director. The DSMB may also make suggestions 

that are not intended to be binding but are to be considered and discussed by the Principal 

Investigator. In the case of conditional approval, after the HSR&D Director issues the 

report, the Principal Investigator will be asked to submit a response within 30 days to 

indicate how the recommendations will be implemented.

When requested by the study PI or at the discretion of the DSMB Chair, the DSMB Chair 

will finalize a short report (a draft of which is prepared by staff at the meeting) that the PI

may distribute to the Human Subject Subcommittees/Institutional Review Boards (IRBs) 

of the participating sites, informing them of any safety issues in the study. Since the 

Human Subject Subcommittees/IRBs will not have access to blinded data results, the 

report will provide them some assurance that the DSMB is monitoring the safety of study 

patients and will make them aware of any safety issues. The report needs to be worded 

such that blinded study results are not revealed unless absolutely necessary.

The DSMB reports are provided to the HSR&D, Director who determines the action 

needed for each report, transmits the report with a cover letter of the action to the 

appropriate PI with a copy to the Associate Chief for Research, Center Director, and 

Hospital Director.

7.3. Midyear Review 

At mid-year between annual reviews, Principal Investigators who are required to submit a 

mid-year report should upload a (4-6 page) mid-year progress report to http://art.pugetsound.med.va.gov/ChooseProject.cfm as a single paginated PDF (include page 

number, PI, and date on each page) with table of contents in the following format:

Table of contents. 

Principal Investigator‟s Summary of Progress Cover Letter (at most 1 

page). The Principal Investigator should prepare a letter covering study 

progress, performance, and important protocol modifications since the last 

review of the study.

Recruitment table or graph showing actual vs. expected recruitment rates over 

time for the entire study and by site

Completeness of follow-up

Status of data collection and data entry and cleaning

Safety: AEs and SAEs classified by group (A vs. B, i.e., blinded), cumulative 

and for the period since the last DSMB review. The report should include a 2 

X 2 table for each site with intervention and control groups and with adverse 

events and serious adverse events. 

Appendices 
HSR&D DSMB Charter Version 1.1 13 

o Previous DSMB feedback reports, if any. The DSMB feedback 

report is generated to reflect the DSMB review and approval of the 

study to continue, and it is signed by the DSMB Chairperson.

The mid-year report will be due mid-year. A reminder will be sent to the Principal 

Investigators four weeks in advance of the due date. Possible actions include acceptance 

without comment, sharing the document with the entire DSMB for an email vote, or 

requesting the Principal Investigator to present the report at a teleconference of the entire 

DSMB.
HSR&D DSMB Charter Version 1.1 14 

Data and Safety Monitoring Board Signature Page

As Director of HSR&D, I approve this charter as the governing policy document of the 

HSR&D DSMB committee. Any non-editorial changes to the terms outlined in this 

Charter will be communicated by the DSMB Program Coordinator to the Chair and 

members.

SIGNED VERSION MAINTAINED ON HSR&D SERVER; REQUESTS FOR 

SIGNED VERSION MAY BE SUBMITTED TO JOSHUA.ROBINSON@VA.GOV

Signature, Director HSR&D Printed Name Date

 
Appendix A - Versioning

HSR&D DSMB Charter Version 1.1 15

Version Details of Change Approval Date

1.0 Establishment of Charter 6/15/12

1.1 Membership Update 7/3/12
Appendix B – DSMB Roster

HSR&D DSMB Charter Version 1.1 16

HSR&D Data Safety and Monitoring Board 2011 Board

Name Role Term Background Location Contact

Lisa Dixon, MD, MPH Chair 2012-2015 IRB, Physician, Researcher Columbia LDixon@psych.umaryland.edu

Joe Collins, ScD Member 2010-2013 Biostatistician/Researcher Perry Point Joseph.Collins2@va.gov

Ying Lu, PhD, MS Member 2012-2015 Statistician Palo Alto Ying.Lu@va.gov

Hanna E. Bloomfield, MD, MPH Member 2011-2014 Physician, Researcher Minneapolis Hanna.Bloomfield@va.gov

Martin Laurence Lee, PhD, Cstat Member 2012-2015 Biostatistician/Researcher West LA Martin.Lee@va.gov

Marcia Valenstein, MD, MS Member 2012-2015 Physician, IRB, Researcher Ann Arbor marciav@umich.edu

Todd Wagner, PhD Member 2011-2014 Health Economist Menlo-Park Todd.Wagner@va.gov

Staff

Name DSMB Role HSR&D Role Location Contact

David Atkins, MD, MPH Program Manager QUERI Director VACO David.Atkins@va.gov

Joshua Robinson, MPH Program 

Coordinator

Health Science Specialist VACO Joshua.Robinson@va.gov
Appendix C – COI Template

Page 1 of 1

Conflict of Interest Declaration

Updated 6/11/2012

CONFLICT OF INTEREST DECLARATION (HSR&D DSMB MEMBERS)

This form is to be used by HSR&D DSMB members to declare any conflict of interest with 

projects to be reviewed at a convened meeting of the HSR&D DSMB.

Instructions:

1. The Conflict of Interest Declaration must be signed after you review the mid-year or 

annual meeting agenda.

2. At the meeting, all DSMB members must turn-in these forms prior to the start of the 

meeting. Members attending via video or teleconference (or meetings held by 

teleconference) should fax or scan and email the form to the HSR&D DSMB Program 

Coordinator.

3. Members having a conflict of interest with a particular project must declare it prior to the 

discussion of the project and leave the room during the discussion and voting. Members 

participating via video or teleconferencing must disconnect. Members will be summoned 

to return upon completion of the voting.

4. Members may remain in the room or on the call if requested by the Chair to provide 

information but must leave or disconnect after the information has been presented.

CONFLICT OF INTEREST DECLARATION

I have reviewed the agenda for the HSR&D meeting to be held on .

Please check one of the boxes below and identify which project(s) for which you have a COI.

I have reviewed the agenda for the above meeting and am not involved in and have no 

other conflict of interest regarding any of the projects to be reviewed at the above 

meeting. I will promptly update this declaration should I discover such a conflict during 

the meeting.

I am involved or I have another type of conflict of interest in the projects listed below. I 

will leave the room during any discussion and vote on these projects. I have no other 

conflicts of interest regarding any of the other projects to be reviewed. I will promptly 

update this declaration should I discover such a conflict during the meeting.

List of projects in which a conflict of interest is being declared:

Printed name:

Signature: Date: