Proposal Submission for DSS Please complete the following form and click “submit” below. Location Office of Sponsored Projects (OSP) The Graduate School Requestor Requestor Email Emails to cc: Additional P.I.'s Proposal Title (long) Proposal Title (short) Sponsor Name Sponsor Contact Sponsor Email Sponsor Phone Proposal Due Date Time Due 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : 00 15 30 45 Announcement # (RFP) Start Date End Date Type of Proposal Competing Education New Pre-Proposal Research Career Award Resubmission Purpose Clinical Other Public Service Research Training Instruction Education Recipient Funding Type Fellowship Graduate Student Fellowship Post Doc P.I. Grant / Contract Subcontract This proposal is a subcontract or the sponsor is a clinical research organization Prime Sponsor Stimulus This is a stimulus-funded package COI Conflict of Interest has been processed in BRR system Conflict Identified? Yes No Budget Numbers P.I. Enter number of months on project. Additional P.I. Enter number of months on project. Post-Doc Enter salary and time on project in months. Grad Students Enter number of students and time on project in months. Undergrad Students Enter number of students and time on project in months. FARS & RPT percentage Enter the percentage split between investigators Additional Details Equipment ($5,000+) Materials (specific supplies) Travel To Where City, State, Country Conference Fee Estimate Type of Meeting # of Travelers # of Days Consultant Consultant's Name Daily Rate # of Days Sub-Contracts A formal technical and cost proposal is required for each subcontractor. Facilities and Administration Yes No Will F&A from this project be split between two or more departments? F&A Split % Please indicate the F&A split percentage. Off-Campus Yes No Will any portion of this project be conducted at an off-campus location (a location not owned or rented by the University of Utah)? Explain Please indicate where and for how long this project will be conducted at an off-campus location. F&A Reduction/Waiver Yes No Will a waiver or reduction in the negotiated F&A rate for this project be requested? If yes, then a follow-up email will be sent to you for additional information and the eProposal will be sent to sOSP for review and then to the VP for Research approval.Note: This question can be marked "No" if the sponsoring agency is a private foundation or non-profit entity that has a published rate that limits the F&A allowed for their awards. In this case, no waiver is required. Sponsor Equipment Yes No Will this project involve the use of sponsor equipment or consultants, require university cost-sharing, generate income, or include the extended absence of key personnel? Intellectual Property Issues Yes No Have you discussed any issues with the sponsor - or signed any agreements - related to confidentiality, publications, ownership, data, patents, licenses, or intellectual property? Additional U Resources Yes No Will your project require additional university resources for its performance? Clinical Trial Yes No Is this proposal a clinical trial? Ineligible for Federal Funds Yes No Have you or anyone involved with this project ever been debarred or suspended from receiving Federal funds, been delinquent on any Federal debt, or used any Federal funds for lobbying activities? International Project Yes No Will any part of your project be conducted in, involve travel to, involve personnel from, or be sponsored by a company from another country? Non-U.S. Citizens Yes No Will any non-U.S. citizen or non-U.S. permanent resident (e.g. faculty, staff, students, post-doc trainees) assist or be involved with this project in any way? Non-U.S. Citizens Explanation Please explain. Foreign Travel Yes No Will there be any foreign travel by you or key personnel as part of this project? Foreign Travel Explanation Please explain. IRB or IACUC Yes No Will your project be subject to approval from the IRB or IACUC? Additional Information Comments Please include any relevant information for your proposal that isn't already covered in the above questions, or provide more thorough explanations if necessary.