"Notice of Award"
Notice of Award Date: To: Dept: CC: From: OFFICE OF SPONSORED PROJECTS The following award has been received in the Office of Sponsored Projects via electronic mail. (Attached to this notice you will find the electronic award received from the sponsor.) For NEW first year awards, the PI Name, Title and Sponsor will be forwarded to the VOX and/or DMS Communications for publication. Should you wish to make revisions to the following non-monetary information or do not wish to have the award published; within ONE WEEK of receiving this notice, please send an email to firstname.lastname@example.org . DC Account No.: 5-3XXXX PI Name: Direct Cost: Indirect Cost: Total: Dates: Award No.: Title: Sponsor: In the above listed information, you will find the Dartmouth Account Number assigned to your award, please proceed with the following: 1) BUDGET - FORWARD A SUBCODE DETAILED BUDGET WITHIN 2 WORKING DAYS to Maureen Wetmore or Yvonne Hughes for input. Any questions that you might have concerning your budget, please contact your Sponsored Research Manager. EXCEPTION: We do not require a detailed budget for Modular Awards as Directs Costs will automatically be budgeted into subcode .590 and indirect Costs will automatically be budgeted into subcode .780. 2) SUB-AWARDS – If this award involves sub-awards, please fill out the most current version of the Request for Sub-Award form and return it to the Office of Sponsored Projects. Please contact your Sponsored Research Manager with any questions that you might have. Dartmouth College Office of Sponsored Projects TELEPHONE: (603) 646-3007 11 Rope Ferry Road #6210 FAX: (603) 646-3670 Hanover, NH 03755-1404 EMAIL: email@example.com Request for Preaward Costs or Account Number in Advance of Funding DATE: TO: Office of Sponsored Projects HB 6210 Attn: FROM: Dept.: RE: Funding Source: PI: Expected Start Date: Title: Award #(if available) CPHS # IACUC # Account Number in Advance: Due to a delay in the sponsor's issuing of the official notification of the above referenced sponsored research award, we would like to request a 5-account number in advance of this award notice. In case of non-funding, the department will cover any expenses that are incurred on the account. Preaward Costs: If it were allowable by the sponsor's terms of the sponsored research award, we would like to incur expenses in advance of the anticipated start date. Please confirm that we can start to incur expenses as of (date) ______ on account # _________ or assign a 5-account number for this sponsored research award. We understand that expenses will be deducted from the awarded budget and that, in the case of non-funding, the department will cover any expenses that are incurred on the account. Department Chair: (Authorized Signature) Sponsored Projects: (Approved by) Budget Template D "5" Sub Ref or Fill out Budget as follows: Account Code #1 Description (20 Char) Amount C 539999 2000 Supplies 1,500.00 D 1. "5" Account Number Field: Enter the 5- account number issued to you by the OSP. 2. Subcode Field: Enter the FAS four digit subcode appropriate to the award budget. 3. Ref #1 Field: Leave blank 4. Subcode Description Field: Enter in description of subcode (20 characters or less). 5. Amount Field: Enter the amount to be budgeted for that subcode. 6. D or C Field: Enter "D" to Increase budget Enter "C" to Decrease budget 7. Submit budget to OSP/Information Systems: Blitz to Maureen Wetmore or Yvonne Hughes 0.00 N O TE Please Do Not use Calculations or Lookups when preparing this budget. REQUEST FOR THE ISSUANCE OF A SUB-AWARD: NEW MODIFIED A Notice of Award (NOA) has been received for the project referenced below, which includes funds for a sub recipient. In order to issue a sub-award, this form will need to be completed in its entirety and submitted to your Grant Manager in the Office of Sponsored Projects @ HB 6210. A Statement of Work and Budget are required for each sub recipient request. Should this request be received without a Statement of Work or Budget, it will be returned to the submitting department. Dartmouth College’s Principal Investigator is responsible for the authorization of all information listed on this form and any of its attachments. I. Dartmouth Award Information: Prime Sponsor: Sponsor Award Number: DC Account No.: 5- Subcode: Dartmouth P.I.: Dartmouth Department: II. Sub Recipient Contact Information: Institution Name: Institutional Address: if not institutional address please explain Sub Recipient Contact Phone #: Sub Recipient Email Address: Sub Recipient P.I.: Sub Recipient Co-P.I.: III. Statement of Work: Please attach Statement of Work to this request. If Statement is not attached, request will be returned. IV. Budget: Budget Period: from to: Project Period: from to: New funds for this budget period only: (Attach budget, or request will be returned) (Attach separate budget & Dartmouth P.I. Carryover fund authorized: approval or this request will be returned) V. Terms and Conditions: ** Please list any specific conditions you would like listed as part of the sub-award such as allowability of carryover. Refer to the Prime Sponsor’s NOA if filling out this section or contact your Grant Manager. Use separate sheet if necessary. ** VI. Signature Authorization: I hereby approve the attached Work Statement and Budget for this Project: Principal Investigator (or designee) Date Prepared By: Dartmouth College Cost Transfer Request For Sponsored Activities Date Original Origina Amount Charge l Charge Transaction College of Account To Charge Date Acct# Subcode Description Reference Charge Acct# Subcode *Justification of Redistribution: Approval Signatures Prepare By Date Principal Investigator Date Dean/Executive Officer Date Office of Sponsored Projects Date *Explanation such as "to correct an error", or "to transfer to correct project" are not sufficient. In the case of an error, we must have a full explanation of how the error occurred; and in all instances, a proper certification of the correctness of the charge being transferred. Revised August ALL TRANSFERS MUST BE MADE WITHIN 120 DAYS OF THE ORIGINAL CHARGE. 2001 DARTMOUTH COLLEGE LABOR ACCOUNT DISTRIBUTION CHANGE & WAGE TRANSFER FORM Employee Full Name: Social Security Number: Assignment Number: Contact Person/Department: Please check applicable box(es) Change labor distribution only – Section 1 Change retroactive labor charges only (wage transfer) – Section 2 Change both labor distribution and retroactive labor charges – Sections 1 & 2 Section 1 – Labor Distribution Dollar amount optional for Section 1 only Effective Date: Previous Labor Distribution New Labor Distribution ACCOUNT NUMBER ACCOUNT NUMBER WITH SUBCODE AMOUNT PERCENT WITH SUBCODE AMOUNT PERCENT TOTALS TOTALS Section 2 – Retroactive Labor Charges (Wage Transfer) If moving several payrolls, please list only the total dollar amount to move. Fringe automatically calculates without being listed. Begin Date: End Date: Actual Labor Distribution Charged Retroactive Labor Distribution To Be Charged ACCOUNT NUMBER ACCOUNT NUMBER WITH SUBCODE AMOUNT PERCENT WITH SUBCODE AMOUNT PERCENT TOTALS TOTALS Authorized Signatures Date Comments/Justification for Reallocation Principal Investigator / Project Director Dean / Executive Officer Office of Sponsored Projects Instructions- (Additional Instructions on back of form) 1. One form per employee/assignment number. 2. Distribution must total 100%. 3. Distribution can only contain two decimal place values. 4. If form is /incorrect, Payroll will return to originating department. 5. Any non-grant account changes for prior fiscal year must have Controllers Office approval. 6. If distribution includes 5-account, use Comments section to explain Justification for Reallocation. 7. If using Grant Account(s)-Transfers must be made within 120 days of the original charge. AGREEMENT WITH HITCHCOCK CLINIC Dartmouth College agrees to pay Dartmouth Hitchcock Clinic the fixed sum of From the period ________ to ________. This sum represents payment of salary and fringe benefits for __________’s effort on (Dartmouth Account ) as ________. These costs are broken down as follows: Effort Salary Fringe Total The amounts listed above are based on the % effort for the project and _____ Dartmouth Hitchcock Clinic salary scale _____ Sponsor mandated salary cap Dartmouth Hitchcock will issue quarterly invoices in the amount of __________. I, certify that above amount is reasonable in relation to the work performed and to my projected workload. _____________________________ _______________ Signature (of person being paid) Date In agreement to conditions as above: _______________________________ _______________ Principal Investigator Date _______________________________ _______________ Office of Sponsored Projects Date _______________________________ _______________ Authorized Signature for Hitchcock Clinic Date 9/28/04 Labor Verification Report by Employee From 07/01/03 to 06/30/04 Employee Soc Sec Nbr Dart ID % of Asg Nbr Pos Nbr Organization Account Description Regular Sal Adjustment XXXXX, Judith XXX-XX-XXXX 7XXXXB 2XXXX-5 0XXXXXX Dept XYZ 536XXX~1120 Pilot I 40,500.50 73.00 0.00 537XXX~1120 Pilot II 2,200.10 4.00 0.00 538XXX~1120 Pilot III 12,750.00 23.00 0.00 Assignment Totals: 55,450.60 100.00 0.00 Employee Totals: 55,450.60 100.00 0.00 The above salary charges are reasonable in relation to the work performed on this project. Employee Date Labor Verification Report by Grant Account From 04/01/03 to 03/31/04 Admin: XXXXX, BILL Account: 53XXXX Pilot Project PI: PI-XXXXX, JOYCE Start: 04/01/03 End: 03/31/05 Dept: XYZ Employee Dartmouth Sub % of Name ID Code Salary Salary Adjustment % of Sal John XXXXX 1XXXXY 1050 $50,000.00 50% 0.00 0.00 Subcode Totals: $50,000.00 Ken XXXXX 5XXXXZ 1100 $25,000.00 40% 0.00 0.00 Subcode Totals: $25,000.00 Mary XXXXX 7XXXXN 1120 $33,000.00 75% 0.00 0.00 Subcode Totals: $33,000.00 Account Totals: $108,000.00 0.00 The above salary charges are reasonable in relation to the work performed on this project. Signature Date Dartmouth College Graduate Tuition Remission Effective Date Department or School Student I.D. # Name of Student Mailing Address of Check ______ Tuition: Term Account Amount Tuition of Previous Terms: Term Account Amount I certify that this payment is made solely for the benefit of the above named student, who is a degree candidate. Signature of Originator For Department or School I hereby certify that my previously assigned activities (100%) shown on the last authorization dated was reasonable and without significant variation. I also certify that the proposed assignment of activity is (100%) reasonable. Comments: Date Signature of Student IN-KIND CONTRIBUTION Date _____________ I hereby certify that ___________________________________________________________ (1) Person/Organization has contributed _______________________________________________________________ (2) Item, Service, etc., with date(s) to the project _____________________________________________________________. (3) Title Its value is computed as follows: _______________________ @ $ ___________________; (4) Amount (5) Rate the total value of the contribution is $ __________________________. ______________________________________ _____________________________________ Name (type or print) (Organization) ______________________________________ Signature Description of Service(s): Account Number: