Connecticut State Department of Consumer Protection

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Expenditure Disclosure Form

EXPENDITURE DISCLOSURE FORM FOR MANUFACTURERS SUBJECT TO THE PROVISIONS OF SECTION 75 OF PUBLIC ACT 14-217

                Please note that Senate Bill 257, “AN ACT CONCERNING REPORTING OF PAYMENTS BY MANUFACTURERS TO INDEPENDENTLY-PRACTICING ADVANCED PRACTICE REGISTERED NURSES” was signed by the Governor on May 11, 2015.  This bill significantly altered current reporting requirements.  The first reporting date is from July 1, 2015 to July 1, 2017, and annual, rather than quarterly filings are now required. 

Independently Practicing Advanced Practice Registered Nurse List

Report Submissions First report is due by July 1, 2017 for the period from January 1, 2016 to December 31, 2016.

APRN Payment Report Form(Excel)

Please submit the form in an .xlsx or .csv format.  Each Advanced Practice Register Nurse should have a single line in the spreadsheet for each manufacturer.  The total amount of compensation provided should be placed in the "Total Value of Payment to APRN" field and the minimum threshold for reporting is the same as the federal requirement.  No further explanation is required regarding the types of compensation provided. 

This file should be emailed to DCP.DrugManufacturers@ct.gov with a subject of "APRN Payment Report".  An auto-response will be sent to the email address of the submitter which is proof of your submission.  The Department will contact you if we have any questions about your submission.

Questions concerning this form should be submitted to DCP.DrugManufacturers@ct.gov. Please note that you will receive an auto-response from that email box every time that you submit an email which is your confirmation that we received your email.