Confidentiality and Copyright Agreement Disclosure form

Prior to submission of any proposals on this website, the author must read and agree to the following terms.

1. I understand that any proposal must contain two elements:

suggestions of specific changes to the text of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and/or diagnostic criteria sets; and
data and materials provided in support of such suggested changes.

The suggestions of specific changes to the text of the Diagnostic and Statistical Manual of Mental Disorders and/or diagnostic criteria sets contained within my proposal represent original material, have not been published previously, and are not being considered or submitted for publication elsewhere while under consideration by the American Psychiatric Association. *This question is required.

2. If No, the suggestions of specific changes to the text of the Diagnostic and Statistical Manual of Mental Disorders and/or diagnostic criteria sets contained within my proposal have been previously published or are being considered or submitted for publication elsewhere while under consideration by the American Psychiatric Association. The source(s) at which the suggestions contained within my proposal have been published or are under consideration for publication is/ are:

2. I certify that the information provided above is correct. *This question is required.

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3. The proposal I am submitting has been approved for submission here by each author. *This question is required.

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4. Authors submitting proposals containing data or clinical observations already used in published papers or used in papers that are in press, submitted for publication, or to be submitted in the near future should provide this information and copies of those papers with the submission. I have complied with these criteria. *This question is required.

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5. I have not used in my specific proposal for changes to the text of the Diagnostic and Statistical Manual of Mental Disorders and/or diagnostic criteria sets copyrighted materials of third parties without their permission (note that this does not include materials provided in support of those suggested changes). *This question is required.

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6. To the extent that I am the holder or entitled to be the holder of copyright protection for any and all material contained within my specific proposal, I agree to transfer said copyright to the American Psychiatric Association if all or any portion of the proposal is accepted for publication in the Diagnostic and Statistical Manual of Mental Disorders. Prior to publication, I give permission to the American Psychiatric Association in its sole discretion to copy, share and/or distribute the specific proposal submitted or any portion or version thereof for purposes associated with the review process. *This question is required.

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Disclosure by all authors of financial relationships with any organization, commercial or otherwise, that may have a direct or indirect interest in psychiatric diagnosis, treatment, or the Diagnostic and Statistical Manual of Mental Disorders (DSM) is required at the time of submission and again prior to publication in the DSM. Such reporting must include all equity ownership, profit-sharing agreements, royalties, patents, stock, cash, gifts, speaker fees, honoraria, travel funds, advisory panel payments, and research or other grants from private industry or closely affiliated nonprofit funds. In addition, financial support for the proposal must be disclosed, whether from governmental, nonprofit, or commercial sources.

Nonfinancial forms of support, such as analytic support, or other assistance with preparation of the proposal, must also be acknowledged.

The disclosure must cover the three-year period preceding the submission to the American Psychiatric Association and be updated prior to publication in the DSM. All relevant financial relationships are identified below:

7. Financial Relations

Space Cell	Source of Funds	Amount	Date Received	Purpose
Source 1	Source 1: Source of Funds	Source 1: Amount	Source 1: Date Received	Source 1: Purpose
Source 2	Source 2: Source of Funds	Source 2: Amount	Source 2: Date Received	Source 2: Purpose
Source 3	Source 3: Source of Funds	Source 3: Amount	Source 3: Date Received	Source 3: Purpose
Source 4	Source 4: Source of Funds	Source 4: Amount	Source 4: Date Received	Source 4: Purpose
Source 5	Source 5: Source of Funds	Source 5: Amount	Source 5: Date Received	Source 5: Purpose
Source 6	Source 6: Source of Funds	Source 6: Amount	Source 6: Date Received	Source 6: Purpose
Source 7	Source 7: Source of Funds	Source 7: Amount	Source 7: Date Received	Source 7: Purpose
Source 8	Source 8: Source of Funds	Source 8: Amount	Source 8: Date Received	Source 8: Purpose
Source 9	Source 9: Source of Funds	Source 9: Amount	Source 9: Date Received	Source 9: Purpose
Source 10	Source 10: Source of Funds	Source 10: Amount	Source 10: Date Received	Source 10: Purpose

8. Please attach any additional financial disclosures here (only PDF files):

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9. In the event that all or any portion of my proposal is reviewed for publication in the Diagnostic and Statistical Manual of Mental Disorders, I agree to cooperate with the American Psychiatric Association by providing any additional financial information that may be requested. *This question is required.

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10. My proposal includes the submission of data that has not previously been published. *This question is required.

11. If YES, all sources of funding for the studies that produced unpublished data that I am submitting are identified below:

Space Cell	Source of Funds	Date Received	Purpose
Source 1	Source 1: Source of Funds	Source 1: Date Received	Source 1: Purpose
Source2	Source2: Source of Funds	Source2: Date Received	Source2: Purpose
Source 3	Source 3: Source of Funds	Source 3: Date Received	Source 3: Purpose
Source 4	Source 4: Source of Funds	Source 4: Date Received	Source 4: Purpose

11. I certify that the financial disclosures above are true and correct. *This question is required.

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12. Date submitted *This question is required. This question requires a valid date format of MM/DD/YYYY.

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13. Please sign here *This question is required.

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14. Please add your information *This question is required.

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