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Administration on Children, Youth and Families (ACYF) Grant Web

Reviewer Confidentiality Statement

The content of grant applications is highly confidential. It is critical that no grant reviewer participate in a review of any grant application where a conflict of interest exists or may exist. Therefore, before reviewing a grant application, each grant reviewer will be given a Reviewer Confidentiality Statement to read and affirm by signature.

View a sample Reviewer Confidentiality Statement

 

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ACYF Reviewer Help Line at 1-(866) 796-1613 or TTY 711
Phone lines are open 9 a.m. to 5 p.m. (EST) Monday - Friday

 

This is a sample Reviewer Confidentiality Statement.

ACF CERTIFICATION FORM REGARDING CONFLICT OF INTEREST, CONFIDENTIALITY AND NON-DISCLOSURE FOR REVIEWERS OF GRANT APPLICATIONS

Reviewers are individually responsible for evaluating their own affiliations and financial interest, and those of their close relatives and professional associates, that relate to their duties as reviewers before they review any applications.

Conflict of Interest is defined as: Any action by a reviewer in the grants review or awarding process which would affect, or could appear to affect, the reviewer’s financial interest, or would cause the reviewer's impartiality in the grants process to be questioned. Specific situations include, but are not limited to, the following: A reviewer may not participate in the review or award of a specific grant application in which any of the following has a financial interest:

  1. the reviewer or the reviewer’s spouse, parent, child, or partner;
  2. any organization (including a parent or subsidiary) in which the reviewer or the reviewer’s spouse, parent, child, or partner serves as officer, director, trustee, partner or is otherwise similarly associated;
  3. any organization (including a parent or subsidiary) in which the reviewer or the reviewer’s spouse, parent, child, or partner is negotiating for or has an arrangement concerning prospective employment or other similar association; or
  4. any organization (including a parent or subsidiary) in which the reviewer or the reviewer’s spouse, parent, child, or partner has an interest with respect to any pending grant application competing under the same program as any other grant application to be reviewed by the same committee or group of field researchers.

I have read and understand the above definition of conflict of interest and have examined the attached list of applications to be reviewed, and hereby certify that, based on the information provided to me, I do not have a conflict of interest in any of them. If during the review there is an appearance or actual conflict of interest, I will recuse myself from the review of the application or will obtain an appropriate waiver.

In addition, I fully understand the confidential nature of the evaluation and agree: (1) to destroy or return all materials related to the evaluation; (2) not to disclose or discuss the materials associated with the review, my evaluation, or the review meeting outside of that meeting or with any other individual except as authorized by the grants management officer; and (3) to refer all inquiries concerning the review to the grants management officer.

Application Reviewer

 

Signature ___________________________________

 

Date ______________________

Print Name _____________________________________________________________
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Exhibit X-2.09.2                revised 7/27/2004
effective immediately