Draft CME Submission Form

TMA CME Credit Request
Welcome!

This form is for organizations seeking TMA's support in designating an activity for CME credit. All requests must be submitted using this online form. The person completing the form should be the primary point of contact, responsible for receiving all communications and providing any required information or documentation.

Before You Begin
- To avoid an expediting fee, requests must be submitted at least 60 days before the activity's scheduled date.
- If you have a previous CME activity with missing required documentation, a new CME Activity Pre-application Screening request may be declined until the outstanding documentation is completed.
Steps to Request CME Credit from TMA

1. CME Activity Pre-application Screening*
- Review the TMA Educational Presentation Request Agreement to Terms and Conditions – You must agree to the Agreement and Fee Schedule. You will be asked to confirm your agreement after the Fee Schedule.
- Provide organization and basic activity details
- Submit financial disclosures for planners (for clinical content activities only)
*If accepted, you will receive access to the CME Application. Acceptance of the screening form does not guarantee approval for CME credit.

2. CME Application

Submit detailed information regarding the proposed educational activity.

*If approved, you will gain access to the required Pre-Activity Tasks.

3. Pre-Activity Tasks

Complete and obtain approval for all required documentation before the activity takes place.

*After the Pre-Activity Tasks have been submitted and approved, you will gain access to the required Post-Activity Tasks.

4. Post-Activity Tasks

Submit all required documentation no later than 30 days following the conclusion of the activity.

Deadlines Matter

Failure to complete steps on time may result in denial of future CME credit requests from your organization.

Important Guidelines
- Organizations may not state that CME credit "has been applied for," "is pending," or use similar language. Doing so will result in automatic disqualification.
- Ineligible Organizations: Do not submit a request if your organization’s primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Examples include:
  
  Advertising, marketing, or communication firms whose clients are ineligible companies
  
  Bio-medical startups that have begun a governmental regulatory approval process
  
  Compounding pharmacies that manufacture proprietary compounds
  
  Device manufacturers or distributors
  
  Diagnostic labs that sell proprietary products
  
  Growers, distributors, manufacturers, or sellers of medical foods and dietary supplements
  
  Manufacturers of health-related wearable products
  
  Pharmaceutical companies or distributors
  
  Pharmacy benefit managers
  
  Reagent manufacturers or sellers
How to Save and Resume Later

If you need to pause and complete the form later, follow these steps:
- Click the SAVE button at the bottom of the form.
- In the pop-up, click Skip Create an Account. ⚠️ Do not click Sign up with email.
- Enter the email address where you want to receive the return link.
- Check your email for a message from JotForm with your unique link.
- When ready, click the link to resume.
If you do not see the email, please check your spam/junk folder.

Questions?

Please contact us at cme@texmed.org for assistance.
Organization Type and Name

Select the type of organization requesting CME credit and enter the organization's name. If you are completing this form on behalf of another organization, select the type that best describes the organization you are representing. Not sure if the organization is a 100% Membership Group? Click the link to verify: 100% Membership Groups
Organization Type*

County Medical Society100% Membership GroupResidency ProgramAll other organizations/groups
Name of organization*
Enter the full name without abbreviations.
Are you working with any other organizations for this activity?*

YesNo
List name of organization(s)*

CME Activity Fee Schedule – County Medical Society

Required (based on activity type)
- Single Activity
  One-time event
  Fee: $100
- Same Activity Offered Multiple Times
  Same content presented multiple times to different audiences
  Fee: $100 per event
Additional (if applicable)
- Continuous Certification (MOC)
  Simplified MOC process available for these boards: ABA, ABIM, ABP, ABS
  Fee: $500
- Commercial Support
  For activities receiving grants from ineligible companies:
  - 1–3 grantors: $50
  - 4–6 grantors: $100
  - If TMA applies: $150 per grant application
- Expedite Request
  For requests submitted after the deadline
  Fee: $100
CME Activity Fee Schedule – 100% Membership Groups

Required (based on activity type)
- Single Activity
  One-time event
  Fee: First one-hour activity: $0
  Subsequent activities: $2,500 base fee + $500 per additional day
- Same Activity Offered Multiple Times
  Same content presented multiple times to different audiences
  Fee: $2,500 base fee + $250 per additional event
Additional (if applicable)
- Continuous Certification (MOC)
  Simplified MOC process available for these boards: ABA, ABIM, ABPath, ABS
  Fee: $500
- Commercial Support
  For activities receiving grants from ineligible companies:
  - 1–3 grantors: $50
  - 4–6 grantors: $50
  - If TMA is requested to apply: $150 per application
  Note: Commercial support is different from exhibit fees.
- Expedite Request
  For requests submitted after the deadline
  Fee: $250
CME Activity Fee Schedule

Required (based on activity type)
- Single Activity
  One-time event
  Fee: $2,500 base fee + $250 per additional day
- Same Activity Offered Multiple Times
  Same content presented multiple times to different audiences
  Fee: $2,500 base fee + $250 per additional event
Additional (if applicable)
- Continuous Certification (MOC)
  Simplified MOC process available for these boards: ABA, ABIM, ABPath, ABS
  Fee: $500
- Commercial Support
  For activities receiving grants from ineligible companies:
  - 1–3 grantors: $50
  - 4–6 grantors: $50
  - If TMA is requested to apply: $150 per application
  Note: Commercial support is different from exhibit fees.
- Expedite Request
  For requests submitted after the deadline
  Fee: $250
Confirmation of Agreement

By checking this box, the organization agrees to the TMA Educational Presentation Request Agreement to Terms and Conditions Attendance Requirements, and Fee Schedule.

Primary Contact
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Is the billing information the same as the applicant information?*

YesNo
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.

Basic Activity Information
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Title/Topic*
Purpose of the Activity (brief)*
Estimated CME hour requested (.25-hour increments)*
Who is the intended audience?
Physicians:   list specialites
Other health care professionals:   list types
Other professions:*:list professions

Financial Disclosures
Please review the topic descriptions below before answering the next question.
- Clinical topics: include content related to diagnosis, treatment, and patient care.
- Non-clinical topics: include areas such as leadership, communication skills, policies, procedures, and other related subjects.
Which type(s) of topic(s) does your activity address?*

ClinicalNon-clinical
Instructions for CME Financial Relationship Disclosures

TMA is required to identify and mitigate relevant financial relationships before the planning of any CME activity begins. Please follow the steps below:

1. Distribute the Disclosure Form
Download the Collection of Financial Relationships Form and send it to all individuals who may be involved in planning the activity.

Note: Individuals who do not submit this form or decline to provide the required information cannot participate in the planning process.

2. Upload a Sample Disclosure Form
Upload one completed disclosure form as an example.

3. Complete the “Individuals in Control of Content” Section
List all individuals who are involved in the planning, development, or delivery of the activity.

TMA Review and Mitigation

TMA will review all submitted disclosures. If any financial relationships are identified as relevant, TMA will contact you to coordinate the required mitigation steps.

A relevant financial relationship does not automatically disqualify someone from participating. However, in accordance with accreditation standards, all relevant financial relationships must be mitigated before the individual can participate in planning or delivery of content.

If the activity is approved, you will be responsible for collecting disclosure forms from faculty and any other individuals in control of content.
Upload one sample of a completed financial relationship form*

Cancelof
Instructions: Individuals in Control of Content

Using the information provided in the disclosure forms, complete the applicable columns below for each individual in control of content.

Required for All Individuals (Complete Columns 1–3):

(1) Name
List the individual’s full name.

(2) Role(s)
Indicate their role(s) in the activity (e.g., planner, course director, moderator, presenter, author, patient, or other — please specify).

(3) Disclosure Status
Select Yes or No from the dropdown to indicate whether the individual disclosed any financial relationships.

Required Only If Financial Relationships Were Disclosed (Complete Columns 4–8):

(4) Ineligible Company(ies)
List the name(s) of any ineligible company(ies) with which the individual has a financial relationship.

(5) Nature of Relationship(s)
Specify the nature of the financial relationship(s) (e.g., speaker, consultant, stockholder).

(6) Therapeutic Area(s)
If the relationship is specific to a therapeutic area, list or describe it.

(7) Has the Relationship Ended?
Select Yes or No from the dropdown to indicate whether the financial relationship ended within the past 24 months.

(8) Email
Provide the individual’s email address if they disclosed financial relationships.

* Example of how to list the information:
List all individuals in control of content for planning this activity. Click the gray "+Add Row" button to include additional individuals. Use the scroll bar or the Tab key to view and complete all required fields. *
TMA Staff - Mechanisms used to mitigate financial relationships.
Indicate the mechanism(s) used to mitigate each relevant financial relationship (e.g., peer review, slide review, recusal from content, etc.). If no relevant financial relationships were disclosed, enter N/A.
Reviewer Comments
Should be Empty:

TMA CME Credit Request

Instructions for CME Financial Relationship Disclosures

TMA Review and Mitigation

Instructions: Individuals in Control of Content

Required for All Individuals (Complete Columns 1–3):

Required Only If Financial Relationships Were Disclosed (Complete Columns 4–8):