Name *

Email *

Affiliated Institution and Title *

Address *

Proposed Publication Title *

Therapeutic Area(s) *

Initial Author List *

Publication Type *

Targeted Audience or Readership *

Target Journal *

Would the publication be submitted to an open access and peer-reviewed journal? * *

Project Initiation Date *

Publication Submission Date *

Description of Publication *

Please include information on why this publication would be of value to the medical community.

Description of Support Requested *

Note: Priority will be given to requests to provide support in the form of medical writing support through a third-party medical writing agency of NNI’s choosing.
Authorship Requirements:
NNI only supports publications that meet the criteria of the International Committee of Medical Journal Editors (ICMJE) Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as well as Good Publication Practice (GPP) for Communicating Company-Sponsored Medical Research:
Please confirm that for the publication(s) described above: (A) the publication(s) will satisfy all ICMJE criteria, and (B) all authors will satisfy all ICMJE criteria.

1. The publication(s) will satisfy ICMJE criteria? * *

2. All authors will make substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work * *

3. All authors will draft the work or review it critically for important intellectual content * *

4. All authors shall provide final approval of the final version to be published * *

5. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. * *

Sunshine Reporting:
Pursuant to NNI policy, NNI does not provide financial compensation for authorship of publications, including clinical trial manuscripts, abstracts, or review papers. Authors should be aware, however, that pursuant to the “Sunshine” provisions of the Patient Protection and Affordable Care Act, NNI is required to report costs associated with editorial/writing support (“publication support”) as a transfer of value, when that support is provided to a US-licensed physician or teaching hospital. As an author of an NNI-supported publication, if you receive publication support, the value of this support will be reported to the Centers for Medicare and Medicaid Services (CMS), as required by law.

Please confirm that you and your fellow authors have read and understood NNI’s policy regarding “Sunshine” reporting. * *

Medical Accuracy Review:
If NNI approves your request for support, NNI will require that it have an opportunity to perform a medical accuracy review prior to submission. To facilitate this review, requesting authors will be required to provide NNI with a copy of any proposed publication at least ninety (90) days prior to submission of the manuscript to an appropriate journal(s). If NNI’s medical accuracy review produces recommendation to the author(s) that the author(s) decide not to accept, that decision must be disclosed in relevant publication’s mandatory disclosures.

Please confirm that you and any fellow authors have read and understood NNI’s requirements relating to medical accuracy review of proposed publications. *

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