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									    NETSCC Application Support Form for FULL applications only
                          This is a template to assist with completing the form. It cannot be
                          submitted as a Word document as the application must be submitted
                          online. The content can be copied onto the online form however.


                       APPLICATION (Full) - RESEARCH DETAILS

    Research details form
    Programme Name                                         Defaults to the programme you are applying for
    Funding Opportunity                                    Defaults to the call you are applying for
    Funding Cycle                                          Defaults to the stream of funding you are
                                                           applying for
    Contracting Organisation
    The contracting organisation must be selected
    from our current list – you will need to contact the
    funding team if your organisation is not listed.
    Full title of project
    Your full project title. (Limit 300 characters)



    Research Type
    Primary/Secondary/Evidence Synthesis
    Proposed start date, duration (in months) (end
    date is calculated from start & duration for you)
    Start date must be in the future and on the first of
    the month.
    How did you hear about this call?
    Selected from dropdown list or ‘other’ with
    description (Limit 100 characters)
    Total costs requested
    Requested research funding
    Total NHS support & treatment costs
    Proposed treatment costs could be savings



    Lead Applicant Information
                                          Carbon reduction guidelines
    Have you read the NIHR Carbon reduction guidelines? These can be found at
    http://www.nihr.ac.uk/files/NIHR_Carbon_Reduction_Guidelines.pdf and this link is           Radio Check
    also shown on the MIS page. This is mandatory to confirm you have read the                  box
    carbon reduction guidelines.


                                      Agreement to terms and conditions
     A link to terms and conditions is provided on the MIS when you register (see
    http://www.netscc.ac.uk/MIS/terms.asp). For further information about research roles please see
    funding programme guidance.




NETSCC Research Application Support. This is not a valid Application form
                                                                                                              Page 1 of 35
    NETSCC Application Support Form for FULL applications only
                          This is a template to assist with completing the form. It cannot be
                          submitted as a Word document as the application must be submitted
                          online. The content can be copied onto the online form however.
    Contact Information form

    Details of Chief Investigator
    Title
    First Name
    Middle Name
    Last Name
    Suffix
    Specialty
    Organisation (Affiliated Organisation form)
    You can select or add Affiliated Organisations as
    required. One must be your Primary organisation
    Role and organisation
    Your post, department and your organisation.
    Identify whether this is your Primary organisation
    and state your type of affiliation e.g. Employee or
    Board Member (selected from a drop down list of
    values)




                                  APPLICANT’S INFORMATION

    Specify Role in research
    (Limit 200 characters)
    % FTE commitment
    Your proposed percentage of full time
    commitment to the research

    Do you currently hold an NIHR award
    Yes/No selection
    if yes please specify
    (Limit 100 characters)
    Date of commencement
    dd/MM/yyyy
    Is this a full time post?
    Yes/No Selection
    If no please give %wte (whole time equivalent)
    Percentage of your work covered by this award
    Current grade
    Your current staff grade
    Current Research Commitments
    Summarise any current research commitments (Limit 200 characters)




NETSCC Research Application Support. This is not a valid Application form
                                                                                                Page 2 of 35
    NETSCC Application Support Form for FULL applications only
                          This is a template to assist with completing the form. It cannot be
                          submitted as a Word document as the application must be submitted
                          online. The content can be copied onto the online form however.

    Lead Applicant Information – Please provide an approximate breakdown of how your current
    appointment is divided between the following activities
       Service/Clinical %            Research %                  Teaching %                     Other %


    Please specify ‘other’ research activity if applicable (Limit of 100 characters)


    What is your Nationality
    You can select from a drop down list – (currently      This question is no longer required or on the form
    this shows Country rather than nationality – this
    will be revised as soon as possible)
    Do you require or currently hold a working
    permit or visa
    Yes/No Selection
    If you require or hold a working permit or visa please give details
    (Limit 200 characters)



    Are you on a fixed term contract?
    Yes/No Selection
    If yes please give details (include expiry date)
    (Limit 200 characters)


    Do you require an honorary contract to
    complete this work? (Yes/No)
    Yes/No Selection

    Lead Applicant Information – Preferred Administrative Contact
    Do you wish us to contact you, the lead
    applicant, regarding this information?
    Yes/No selection.
    Please select a response on the electronic form
    as this is a mandatory selection. It is
    recommended that you are always the main
    contact for any application process as tasks
    associated with the application will be allocated to
    you and appear on your NETSCC MIS home
    page.
    Name, Role and Organisation (contact
    information)
    (Limit 600 characters)


    Lead Applicant Information – Qualifications

    Degree / professional qualification                    Awarding body, date of award
    List your higher and professional qualifications.      Provide information about the examining body.
    You will be asked to add these separately on the       You will be asked to add these separately on the
    electronic form.                                       electronic form.



NETSCC Research Application Support. This is not a valid Application form
                                                                                                                Page 3 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.


    Lead Applicant Information – Present and Previous Positions Held
    Job title
                                                          Period of employment (From/To)
    CV information. Please see funding programme
                                                          If this is a current post you will only need to enter
    guidance for suggested job history requirements
                                                          a start date.
    You will be asked to add these separately on the
    electronic form




    Complete if Lead Applicant is a patient/service user or carer

    Are you a patient/service user or carer?
    You must respond to this question,
    Yes/No Selection


    Please tell us about your knowledge, skills and experience that are relevant to this
    application. You are not required to provide a CV.
    Only complete if lead applicant is a patient/service user or carer. Please read the guidance provided
    on what information to include. (Limit 1000 characters)




    Lead Applicant Information – Recent Relevant Publications
    Recent relevant publications (Suggest last 6 relevant) Please note if you choose to ‘view
    publications’ this will only currently show publications you have previously notified us about that
    relate to NETSCC funded research for which you are or were Chief Investigator.
    You will be asked to add information about publications individually in the form. Any information about
    publications related to your NETSCC managed research that you have already provided should be
    listed in this section but you should only select recent relevant research from this list.
    Other recent publications that you consider relevant to this proposal should be added
    Required Information:
    Date: dd/MM/yyyy (please enter 01/01/yyyy. This will eventually just ask for the year)
    Periodical Name: (Limit 200 characters)
    Article Title: (Limit 200 characters)
    Full Reference : (Limit 100 characters)
    Authors: (Limit 1500 characters)




NETSCC Research Application Support. This is not a valid Application form
                                                                                                                  Page 4 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.
    Recent relevant publications (Suggest last 6 relevant) Please note if you choose to ‘view
    publications’ this will only currently show publications you have previously notified us about that
    relate to NETSCC funded research for which you are or were Chief Investigator.
    You will be asked to add information about publications individually in the form. Any information about
    publications related to your NETSCC managed research that you have already provided should be
    listed in this section but you should only select recent relevant research from this list.
    Other recent publications that you consider relevant to this proposal should be added
    Required Information:
    Date: dd/MM/yyyy (please enter 01/01/yyyy. This will eventually just ask for the year)
    Periodical Name: (Limit 200 characters)
    Article Title: (Limit 200 characters)
    Full Reference : (Limit 100 characters)
    Authors: (Limit 1500 characters)




    Lead Applicant Information – Research Grants Held


    Research grants held including NIHR Awards
    List any research grants – you will be asked to add them individually to the form. Any NETSCC
    managed research grants you currently have should automatically appear on your form.
    Required information:
    Title: (Limit 300 characters)
    (Funding) Source: (limit 95 characters)
    Role (in this research grant): (limit 95 characters)
    Funding Period: (from – to)




NETSCC Research Application Support. This is not a valid Application form
                                                                                                              Page 5 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.




                     RESEARCH TEAM AND SUPPORTING ROLES


    Name, Organisation, Post Held, Department, Organisation, Role, email address, phone number,
    Access rights, None, (Read Only (excl financials), Edit Access (Excl Financials), Edit Access (Incl
    Financials).
     Add your co-applicants for this proposal in this form. You will need their email address
        (preferably their organisation one) so that they can accept participation and contribute to the
        application by logging into the MIS providing certain cv information and any other contribution to
        the application that you have agreed with them. You control the level of access your co-
        applicants have to the application form. Access can currently be granted as view only, edit
        access excluding financial information edit access including financial information. Summary
        financial information can be seen by all applicants but not detail. You can select and change this
        access at any time during your application process. If you have added a co-applicant in error or
        made a mistake with the email contact, you should delete this contact and add as a new contact.
        You will not be able to ‘amend’ this information on their record. Once you have added your co-
        applicant co-applicants you can send them a notification from this form that will register them and
        invite them to contribute to the application by logging into the NETSCC MIS.

       Add the contacts that you have nominated as signatories for this application. As a minimum you
        should provide contact information (Name Role Institution and email address) for the Senior
        Manager Sponsor, Financial Director/Administrative Authority and … - see programme guidance
        information for further details. You will need their email address so that they can accept their
        participation and contribute to the application by logging into the MIS to accept their role and
        electronically ‘sign’ the application after submission.

    You also have the opportunity to add an administrative contact and allow them full access to the
    application to support you in its completion.




NETSCC Research Application Support. This is not a valid Application form
                                                                                                              Page 6 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.


                      PATIENT AND PUBLIC INVOLVEMENT (PPI)

    Were patients and the public actively involved
    in identifying the research topic or prioritising
    the research questions?
    Yes/No Selection
    Were patients and the public actively involved
    in preparing this application?
    Yes/No Selection

    If yes to either or both of these questions, please give details. Describe how patient and public
    involvement has informed and/or influenced the development of the application and how
    patients and the public have been involved.
    (Limit 1200 Characters)



    If no to either or both of the previous questions, please explain why patient and public
    involvement was not necessary.
    (Limit 1200 Characters)



    Planned patient/public active involvement in proposed research


    This is a selection list and you should select as many of the check boxes which are relevant.
    Depending on the responses you should complete the additional questions in the following two boxes.
    Design of the research?
    Management of the research?
    Developing participant information resources?
    Undertaking / analysing the research (e.g. member of research team)?
    Contributing to the reporting of the research?
    Dissemination of research findings?
    Other?
    No plans for involvement


    If active involvement is planned, please give more details, including how it will benefit the
    research, the reasons for taking this approach and arrangements for training and support.
    You will need to complete this if you have selected any items in the list. (Limit 1200 Characters)



    If there are no plans for active involvement, please explain why it is not thought necessary.
    You will need to complete if you have not selected any of the items in the previous list. (Limit 1200
    Characters)




NETSCC Research Application Support. This is not a valid Application form
                                                                                                            Page 7 of 35
    NETSCC Application Support Form for FULL applications only
                          This is a template to assist with completing the form. It cannot be
                          submitted as a Word document as the application must be submitted
                          online. The content can be copied onto the online form however.




                             PREVIOUS APPLICATION HISTORY

    Has this application or a similar application
    previously been submitted to this or any other
    funding body?
    Yes/No Selection

    Applications submitted to NETS programmes
    Any previous applications that you have submitted to NETSCC programmes will be listed in this
    section. You have the opportunity to identify if they are relevant (yes/no) to this current application and
    to Edit information as described in the two questions below.
    You can Add any applications in progress submitted to other funders in this section using the add
    facility.
    Required information
    Project title: (Limit 300 characters)
    Funding Body: (Limit 100 characters)
    Funding Scheme: (Limit 100 characters)
    Application reference Number: (Limit 30 characters)
    Application type: Selection is Expression of Interest, Outline or Full
    Outcome: Selection - pending decision, funded, not funded, provisionally funded, funded with
    revisions
    Date of Outcome: dd/MM/yyyy


    Description of Funding – Please indicate how your current research proposal differs from this
    previous application
    Required information (Limit 1500 characters)




    Description of Funding – If unsuccessful, please indicate why
    Required information (Limit 1500 characters)




NETSCC Research Application Support. This is not a valid Application form
                                                                                                                  Page 8 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.




                                       CASE FOR SUPPORT


    Summary of Research (found on form Case for Support)
    See funding opportunity guidance
    (Limit 6500 characters)




    Abstract (in plain English) (found on form Case for Support)
    See funding opportunity guidance
    (Limit 6500 characters)




                              BACKGROUND AND RATIONALE


    What is the problem being addressed?
    See funding opportunity guidance
    (Limit 3000 characters)




    Why is the research important in terms of benefits to patients and the NHS?
    See funding opportunity guidance particularly for responses in this section
    (Limit 3000 characters)



    Please provide evidence explaining why this research is needed now
    See funding opportunity guidance
    (Limit 3000 characters)




    Aims and Objectives
    See funding opportunity guidance
    (Limit 3000 characters)


NETSCC Research Application Support. This is not a valid Application form
                                                                                               Page 9 of 35
    NETSCC Application Support Form for FULL applications only
                          This is a template to assist with completing the form. It cannot be
                          submitted as a Word document as the application must be submitted
                          online. The content can be copied onto the online form however.
    Aims and Objectives
    See funding opportunity guidance
    (Limit 3000 characters)




                                CHANGES FROM FIRST STAGE

    Changes from the first stage1/Outline Stage
    See funding opportunity guidance. Only complete if there has been a previous stage to this
    application otherwise enter N/A in this response.
    (Limit 6500 characters)




                                DISSEMINATION AND OUTPUT

    Please describe your plans for disseminating the findings of this research.
    See funding opportunity guidance.
    (Limit 3000 characters)



    Expected Output of Research/Impact
    See funding opportunity guidance.
    (Limit 3000 characters)




                                      RELEVANT EXPERTISE

    Strengths of research team – contribution of each member
    See funding opportunity guidance
    If known, you should identify your planned co-applicants and their institutions, the role they will take
    and the strengths of individuals to the team.
    (Limit 3000 characters)



    Please declare any conflicts or potential conflicts of interest that you or your co-applicants
    may have in undertaking this research, including any relevant, non-personal & commercial
    interest that could be perceived as a conflict of interest.
    See funding opportunity guidance. (Limit 2000 characters)




NETSCC Research Application Support. This is not a valid Application form
                                                                                                               Page 10 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.




NETSCC Research Application Support. This is not a valid Application form
                                                                                               Page 11 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.




                                           DETAILED BUDGET


                          Budget Years
     Identify the number of years for the proposed research
                – See funding opportunity guidance




                                      PROJECT FINANCIALS

    Posts & Salaries – Summary
    Totals
    Summary posts costs
    for HEI costs, NHS
    research costs,
    commercial costs
    other partnership
    organisation costs           Year 1           Year 2           Year 3           Year 4     Year 5



    Posts and Salaries – Details
    Lead Applicant and Co-Applicants
     Lead Applicant and                                                           Superann.    Current
       Co-Applicants                                               Other           And Nat.    Annual
         Information             Salary        Weighting        Allowances        Insurance     Costs
    Name Organisation         Current         Geographical
    Role                      Salary          Weighting




    Research Staff
        Research Staff
          Information                                                             Superann.    Current
     Staff name, Employee                                          Other           And Nat.    Annual
      Organisation, Role,        Salary        Weighting        Allowances        Insurance     Costs
     Pay Grade, Increment        Current      Geographical
              date               salary        Weighting




NETSCC Research Application Support. This is not a valid Application form
                                                                                                         Page 12 of 35
    NETSCC Application Support Form for FULL applications only
                           This is a template to assist with completing the form. It cannot be
                           submitted as a Word document as the application must be submitted
                           online. The content can be copied onto the online form however.



    Shared Staff
          Shared Staff
          Information                                                               Superann.    Current
     Staff name, Employee                                            Other           And Nat.    Annual
      Organisation, Role,         Salary         Weighting        Allowances        Insurance     Costs
     Pay Grade, Increment         Current       Geographical
              date                salary         Weighting




    Other Staff
           Other Staff
          Information
     Staff name, Employee
      Organisation, Role,         Salary         Weighting                          Superann.    Current
     Pay Grade, Increment         Current       Geographical         Other           And Nat.    Annual
              date                Salary         Weighting        Allowances        Insurance     Costs




    Annual Costs of Posts and Salaries
    Lead Applicant and Co-Applicants
         Information
        Name Lead/Co-
           applicant               Year 1           Year 2           Year 3           Year 4     Year 5




    Research Staff
          Information
       Staff name & Post           Year 1           Year 2           Year 3           Year 4     Year 5




    Shared Staff
          Information
       Staff name & Post           Year 1           Year 2           Year 3           Year 4     Year 5




    Other Staff
          Information
       Staff name & Post           Year 1           Year 2           Year 3           Year 4     Year 5




NETSCC Research Application Support. This is not a valid Application form
                                                                                                           Page 13 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.



    Travel, Subsistence & Conference Fees – Summary
    Total Journeys Costs See funding opportunity
    guidance
    Total Subsistence Costs See funding opportunity
    guidance
    Total Conference fees See funding opportunity
    guidance

    Travel, Subsistence & Conference Fees – Details
    Journey Costs
         Description
        Journey Detail
     Add columns for years       Year 1           Year 2           Year 3           Year 4     Year 5
          as required            Costs            Costs            Costs            Costs      Costs



    Subsistence
         Description
    See funding
    opportunity guidance
    Add columns for years        Year 1           Year 2           Year 3           Year 4     Year 5
          as required            Costs            Costs            Costs            Costs      Costs



    Conference Fees
         Description
    See funding
    opportunity guidance
    Add columns for years        Year 1           Year 2           Year 3           Year 4     Year 5
          as required            Costs            Costs            Costs            Costs      Costs



    Equipment – Summary
    Total Equipment Costs See funding opportunity
    guidance

    Equipment – Details
           Description
    Description, Unit Price,
      lifetime, reclaimed,
         cost type, Total
    amount (all years) (see
    programme guidance)          Year 1           Year 2           Year 3           Year 4     Year 5
    Add columns for years
            as required



NETSCC Research Application Support. This is not a valid Application form
                                                                                                        Page 14 of 35
    NETSCC Application Support Form for FULL applications only
                           This is a template to assist with completing the form. It cannot be
                           submitted as a Word document as the application must be submitted
                           online. The content can be copied onto the online form however.



    Consumables – Summary
                      Total consumables
                          Total costs

    Consumables – Details
          Description
     Description, cost type,
       total amount. Add
     columns for years as
             required              Year 1           Year 2           Year 3           Year 4     Year 5




    Patient and Public Involvement – Summary

                    Total (total all PPI costs)

    Patient and Public Involvement – Details
         Description
     Description, cost type,
         total amount
     Add columns for years      Year 1              Year 2           Year 3           Year 4     Year 5
          as required



    Other Direct Costs – Summary
    Total other direct costs See funding opportunity
    guidance

    Other Direct Costs – Details
         Description
     Description, cost type ,
      total amount for all         Year 1           Year 2           Year 3           Year 4     Year 5
              years


    Patent and Legal Costs – Summary
    Total patent & Legal costs See funding opportunity
    guidance

    Patent and Legal Costs - Details
         Description
     Description, cost type ,
      total amount for all         Year 1           Year 2           Year 3           Year 4     Year 5
              years

NETSCC Research Application Support. This is not a valid Application form
                                                                                                          Page 15 of 35
    NETSCC Application Support Form for FULL applications only
                             This is a template to assist with completing the form. It cannot be
                             submitted as a Word document as the application must be submitted
                             online. The content can be copied onto the online form however.


    Sub-Contract Costs – Summary
      Total Sub-contracting costs See funding opportunity
                           guidance                                                  Total Costs

    Sub-Contract Costs – Details
         Description
     Description, cost type ,
      total amount for all
              years                  Year 1           Year 2           Year 3           Year 4     Year 5


    HEI Indirect Costs – Summary
    Estates Charges
        Description
       Description, total            Year 1           Year 2           Year 3           Year 4     Year 5
      amount for all years


    Other Indirect Costs
          Description                Year 1           Year 2           Year 3           Year 4     Year 5


    Commercial / Other Partner Organisation Indirect Costs
         Description
        Description, total
            amount                   Year 1           Year 2           Year 3           Year 4     Year 5


    NHS Support and Treatment Costs

    Have you discussed and agreed these support
    costs with The Lead Network? (Yes/No)
    Have you discussed and agreed these treatment
    costs with The Lead Trust? (Yes/No)
    Is the patient care being provided different from
    the usual treatment for the condition? (Yes/No)

    NHS Support Costs
          Description
      Description, cost per
      patient, total amount          Year 1           Year 2           Year 3           Year 4     Year 5


    NHS Treatment Costs
          Description
      Description, cost per
      patient, total amount          Year 1           Year 2           Year 3           Year 4     Year 5




NETSCC Research Application Support. This is not a valid Application form
                                                                                                            Page 16 of 35
    NETSCC Application Support Form for FULL applications only
                          This is a template to assist with completing the form. It cannot be
                          submitted as a Word document as the application must be submitted
                          online. The content can be copied onto the online form however.



    Usual Treatment Costs
          Description
      Description, cost per
      patient, total amount        Year 1          Year 2           Year 3           Year 4      Year 5


    Excess Treatment Costs or Savings
          Description
          total amount             Year 1          Year 2           Year 3           Year 4      Year 5




                                PROJECT FINANCIALS SUMMARY

    Research Costs Requested from Funder
                                                                                   % Costs
                                               Indirect                                          Amount
           Totals             Direct costs                     Total costs         paid by
                                                costs                                           requested
                                                                                    NIHR




    Total Research Costs Requested from
    Funder

    Total NHS Support & Treatment Costs / (Savings)

                                                                                 Total costs
    NHS Support Costs Requested from Networks
    NHS Treatment Costs / (Savings) Requested from
    the NHS
    Total NHS Support & Treatment Costs / (Savings)

    Total Funding Required

                                                                             Amount requested
    Research Costs
    NHS Support & Treatment Costs / (Savings)
    Total Funding Required




NETSCC Research Application Support. This is not a valid Application form
                                                                                                            Page 17 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.




                                   JUSTIFICATION OF COSTS

    Please provide justification for the major sources of expenditure to this research
    See funding opportunity guidance. (Limit 3000 characters)



    Please provide justification for how the research costs have been allocated
    See funding opportunity guidance. (Limit 3000 characters)



    Please provide justification for how NHS support and treatment costs have been allocated
    See funding opportunity guidance. (Limit 3000 characters)




                            MANAGEMENT & GOVERNANCE A

    Research Plan Project Management

    Research Timetable
    See funding opportunity guidance. (Limit 2000 characters)



    Research Management Arrangements
    See funding opportunity guidance. (Limit 2000 characters)



    Has any work relevant to this proposal already
    commenced?
    Yes/No Selection

    If any work related to the proposal has already commenced, please give details of any relevant
    work that has already commenced in the preparation of this research
    See funding opportunity guidance. (Limit 2000 characters)



    Success Criteria and Barriers to proposed work
    See funding opportunity guidance. (Limit 2000 characters)



    Is Clinical Trials Approval required
    Yes/No Selection



NETSCC Research Application Support. This is not a valid Application form
                                                                                                 Page 18 of 35
    NETSCC Application Support Form for FULL applications only
                           This is a template to assist with completing the form. It cannot be
                           submitted as a Word document as the application must be submitted
                           online. The content can be copied onto the online form however.


                              MANAGEMENT & GOVERNANCE B

    Does the proposed research raise any ethical
    issues?
    Yes/No Selection

    If yes, discuss how the issues will be addressed
    See funding opportunity guidance
    (Limit 1600 characters)



    Is ethical approval required from a local
    research ethics committee?
    Yes/No Selection

    If yes, please detail how and when you intend to get ethical review completed
    See funding opportunity guidance
    (Limit 1600 characters)




    If ethics approval is NOT required, then justify
    See funding opportunity guidance
    (Limit 1600 characters)




                                                                                                 Tick those
    Does the research involve
                                                                                                 that apply
    Clinical investigations or other studies of medical studies                                       
    Clinical trial of investigational medicinal products (CTIMP)                                      
    Exposure to ionising radiation                                                                    
    Gene therapy medicinal product                                                                    
    Study administering questionnaires/interviews for qualitative or mixed analysis                   
    Study involving use of qualitative methods only                                                   
    Study limited to working with animals                                                             
    Other clinical trials or clinical investigations                                                  
    Experimentation on human participants                                                             
    Will animals be tested during this study                                                          
    The use of human tissue                                                                           
    The use of biological samples                                                                     




NETSCC Research Application Support. This is not a valid Application form
                                                                                                              Page 19 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.
    If you have checked any of the above, please justify the use of human participants and the
    numbers involved and/or the nature and quantity of material to be used
    See funding opportunity guidance
    (Limit 1000 characters)




    If human participants will be used, will there be
    equal numbers of male and female
    participants?
    Yes/No Selection
    Does the programme involve the administration
    of drugs, chemical agents or vaccines to the
    participants
    Yes/No Selection
    Have any appropriate regulatory bodies already
    granted the necessary approvals
    Yes/No Selection


    If yes please specify
    See funding opportunity guidance
    (Limit 1000 characters)




NETSCC Research Application Support. This is not a valid Application form
                                                                                                 Page 20 of 35
    NETSCC Application Support Form for FULL applications only
                               This is a template to assist with completing the form. It cannot be
                               submitted as a Word document as the application must be submitted
                               online. The content can be copied onto the online form however.




                                                    RESEARCH PLAN

    The list below is the full list of questions that could be asked in this section. Each question requires a response and allows for a
    minimum of 1500 characters in each response. On the screen, you access the response section by clicking on the ‘add’ button.
    Please note if the response is required (yes under the ‘Required' column in this section) you will need to complete the
    response. You should enter N/A in these responses if you do not have any comments to make.


    Question                                     Response
    Address feedback from first
    stage
    See funding opportunity
    guidance.
    Provide any feedback for the
    first stage of the application
    process that you have taken
    into account in this proposal (if
    this is the first application
    please enter N/A if a response
    is required for this question)
    (Limit 1500 characters)
    Additional alterations
    See funding opportunity
    guidance.
    Provide any further alterations
    you may have made to the
    application since the first stage
    of the application process (if this
    is the first application please
    enter N/A if a response is
    required for this question.)
    (Limit 2500 characters)
    MeSH Terms
    See funding opportunity
    guidance.
    Please provide any MeSH terms
    that relate to this proposal.
    (Limit 1500 characters)
    Design
    See funding opportunity
    guidance.
    Please provide a plan for the
    research design.
    You may wish or be asked to
    upload supporting documents to
    accompany this response.
    (Limit 2000 characters)
    Setting
    See funding opportunity
    guidance.


NETSCC Research Application Support. This is not a valid Application form
                                                                                                                                       Page 21 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.
    Question                           Response
    Please provide a research plan
    for the setting.
    You may wish or be asked to
    upload supporting documents to
    accompany this response.
    (Limit 1500 characters)
    Target Population
    See funding opportunity
    guidance
    (Limit 1500 characters)
    Inclusion/exclusion criteria
    See funding opportunity
    guidance
    (Limit 2500 characters)
    Health Technology
    See funding opportunity
    guidance
    Please provide details of the
    Health Technology being
    assessed.
    (Limit 2500 characters)
    Control Treatment
    See funding opportunity
    guidance
    Please provide details of the
    control treatment.
    (Limit 2500 characters)
    Planned Interventions
    See funding opportunity
    guidance
    Please provide details of the
    Planned interventions.
    You may wish or be asked to
    upload supporting documents to
    accompany this response.
    (Limit 2500 characters)
    Who will deliver the
    intervention?
    See funding opportunity
    guidance
    (Limit 1500 characters)
    Proposed Outcome Measures
    See funding opportunity
    guidance
    (Limit 2500 characters)
    Search Strategy
    See funding opportunity
    guidance
    (Limit 2500 characters)
    Review Strategy

NETSCC Research Application Support. This is not a valid Application form
                                                                                               Page 22 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.
    Question                           Response
    See funding opportunity
    guidance
    (Limit 2500 characters)
    Assessment and Follow Up
    See funding opportunity
    guidance
    (Limit 2500 characters)
    Sample Size
    See funding opportunity
    guidance
    (Limit 2500 characters)
    Statistical Analysis
    See funding opportunity
    guidance
    (Limit 2500 characters)
    Care Pathways in
    Comparative or Randomised
    Trials
    See funding opportunity
    guidance
    (Limit 1500 characters)
    Difference between Current
    and Planned Care Pathways
    See funding opportunity
    guidance
    (Limit 1500 characters)




NETSCC Research Application Support. This is not a valid Application form
                                                                                               Page 23 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.




                               INTELLECTUAL PROPERTY (IP)

    What relevant IP is held by the applicants and how does it relate to this application?
    See funding opportunity guidance
    (Limit 3000 characters)



    Has a full search for existing IP been
    conducted?
    Yes/No selection

    If yes, please provide details of all relevant IP and how it relates to this application.
    See funding opportunity guidance
    (Limit 1500 characters)



    Is there any related or similar (background) IP that exists and what significance (impact) does
    it have to the applicants’ freedom to operate?
    See funding opportunity guidance
    (Limit 3000 characters)



    Will any IP be produced or improved during the
    proposed research?
    Yes/No selection

    If yes, please describe what IPR will be produced or improved.
    See funding opportunity guidance
    (Limit 3000 characters)



    Please describe how any new IP generated through the proposed research will be recognised
    captured and utilised, either through adoption in the healthcare service or through commercial
    exploitation
    See funding opportunity guidance
    (Limit 3000 characters)



    What are the competitive devices, clinical practices or technologies already in use/near to use
    that this IP/innovation will replace, and what are the novel or inventive aspects of the
    IP/innovation proposed that provide an advantage over the current state of the art in this field?
    See funding opportunity guidance
    (Limit 3000 characters)




NETSCC Research Application Support. This is not a valid Application form
                                                                                                      Page 24 of 35
    NETSCC Application Support Form for FULL applications only
                          This is a template to assist with completing the form. It cannot be
                          submitted as a Word document as the application must be submitted
                          online. The content can be copied onto the online form however.
    What are the benefits provided by this IP/innovation over current practice, existing
    technologies, techniques etc. in this field?
    See funding opportunity guidance
    (Limit 3000 characters)



    What are the key current and future barriers to utilising the IP/innovation through adoption in
    the healthcare service or through commercial exploitation, e.g. potential regulatory hurdles?
    See funding opportunity guidance
    (Limit 3000 characters)




                              INVENTION FOR INNOVATION (i4i)

    It is not necessary for applicants to complete this section.
    Please enter ‘not applicable’ in this section




                                           WIDER CONTEXT

    Network Involvement - NIHR Networks

    In your proposed research, do you intend to link to NIHR Networks? If yes, please state which
    networks.
    See funding opportunity guidance
    (Limit 400 characters)



    Please describe the benefits identified from working with networks.
    See funding opportunity guidance
    (Limit 1500 characters)



    Please indicate other organisations (i.e. Research Design Services) that you may have
    contacted in the course of preparing this application.
    See funding opportunity guidance
    (Limit 1000 characters)




NETSCC Research Application Support. This is not a valid Application form
                                                                                                      Page 25 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.

    Clinical Trials' Units (CTU) Participation

    Is a Clinical Trials Unit involved with this
    research proposal?
    Yes/No selection

    Clinical Trials Units Information
    You can Add one or more Clinical Trials Unit.

    Required Information:
    Clinical Trials Unit Name:
    Registration Number if provided:
    Is the CTU receiving CET support funding from NIHR?

    Please describe how you have worked with a Clinical Trials Unit in developing your application
    and what support they will provide
    See funding opportunity guidance (this may not be relevant to you application).
    (Limit 1500 characters)



    If a CTU is not be used, please explain why and who/what will be involved instead
    See funding opportunity guidance
    (Limit 1500 characters)




    Involvement with other partners

    What if any, other NIHR organisations will
    partner this research?
    Selection from a dropdown list which includes
    ‘none’

    Please specify what other NIHR organisations will partner this research
    See funding opportunity guidance
    (Limit 1500 characters)



    Describe the role, if any these will have in the research
    See funding opportunity guidance
    (Limit 1500 characters)



    NHS or partner facilities

    Will NHS facilities, staff or patients be
    involved
    Yes/No selection



NETSCC Research Application Support. This is not a valid Application form
                                                                                                 Page 26 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.
    Will facilities or staff from partner
    organisations be involved in the project
    Yes/No selection

    Please provide contact details of a member of staff in the R&D office at the lead NHS
    Organisation
    See funding opportunity guidance
    Required information :- Contact Name, Job title,Telephone,Email address




    Other sources of funding

    Will this application be supported by any
    other funding body?
    Yes/No selection

    Other Sources of funding
    You have the opportunity to Add this information
    Required Information
    Supporting organisation: (Limit 100 characters)
    Detail any proposed arrangements for shared funding: (Limit 2000 characters)
    Funding Amount:
    Start date:
    End date:


                                   DH Monitoring Information

    A1
    Lead Applicant’s place of work
    Selection from dropdown list
    Lead applicant profession
    Selection from dropdown list
    Is the research multicentre
    Yes/No Selection
    Research region
    Selection from dropdown list

   A2
    UKCRC Health Categories – Relevant Categories

    UKCRC Health Categories
    Select any that apply to the research.See information at www.hrcsonline.net




NETSCC Research Application Support. This is not a valid Application form
                                                                                               Page 27 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.
    A3
    UKCRC Health Research Activities

    Health Research Activity Type                    Health Research Activity Sub-Type
    See HRCS Research Activity Codes
    information at www.hrcsonline.net




                                           RDS Involvement


    Research Design Service Information

    Did you contact a the Research Design
    Service (RDS)
    Yes/No Selection
    If so, please indicate the Region
    Selection from dropdown list
    If not was it because:
    Team has sufficient Methodological Expertise
    Unaware of RDS Support
    Other
    Check box selection with opportunity to add
    ‘other’
    Other (please specify)
    (Limit 100 characters)
    Measure of satisfaction with the RDS input
    Selection from dropdown list:
    Very Satisfied
    Satisfied
    Dissatisfied
    Very Dissatisfied

    To what extent do you feel the quality of your proposal improved as a result of RDS
    involvement?
    (Limit 1000 characters)

    Would you recommend the RDS to other
    people developing research proposals?
    Yes/No selection

    Please expand on your responses above, explaining the reasons for your choices, and
    including details about the extent and nature of the support provided by the RDS. Please also
    add any other comments about your experience of using the RDS.
    (Limit 1000 characters)



NETSCC Research Application Support. This is not a valid Application form
                                                                                                    Page 28 of 35
    NETSCC Application Support Form for FULL applications only
                          This is a template to assist with completing the form. It cannot be
                          submitted as a Word document as the application must be submitted
                          online. The content can be copied onto the online form however.


                                     SUGGESTED REFEREES


    Reviewers suggested by applicant You can suggest up to three reviewers (referees) and
    also indicate up to two reviewers who we should not approach.

                                                 Contact details
                                                 Department
                                                 Institution
                                                 Address1
    Name                                                                             Reason for suggesting
                            Post Held            Address2
    Title, First name*,                                                              this person
                            Specialty            Address3
    Surname*                                                                         (Limit 500 characters)
                                                 County PostCode
                                                 EmailAddress*
                                                 PhoneNumber
                                                 PhoneExtension




    Reviewers not recommended by applicant
                                                 Contact details
                                                 Department
                                                 Institution
                                                 Address1
    Name                                                                             Reason for suggesting
                            Post Held            Address2
    Title, First name*,                                                              this person
                            Specialty            Address3
    Surname*                                                                         (Limit 500 characters)
                                                 County PostCode
                                                 EmailAddress*
                                                 PhoneNumber
                                                 PhoneExtension




NETSCC Research Application Support. This is not a valid Application form
                                                                                                              Page 29 of 35
    NETSCC Application Support Form for FULL applications only
                         This is a template to assist with completing the form. It cannot be
                         submitted as a Word document as the application must be submitted
                         online. The content can be copied onto the online form however.




                                                UPLOADS

    Upload Checklist
    See funding opportunity guidance. You will find a list of uploads that should accompany your
    application at this stage. Select the type and select upload on the form. Further instructions on how to
    complete the upload are provided on screen as well as type of document and size.




                                      ACKNOWLEDGEMENT

    Agreement to terms and conditions
    See funding guidance information
    Acceptance Statement is: ’I have read and understood the terms on which I have been nominated as
    Chief Investigator for this proposal along with the associated documentation and accept this role.’




NETSCC Research Application Support. This is not a valid Application form
                                                                                                               Page 30 of 35
    NETSCC Application Support Form for FULL applications only
                           This is a template to assist with completing the form. It cannot be
                           submitted as a Word document as the application must be submitted
                           online. The content can be copied onto the online form however.



                                         REVIEW AND SUBMIT


     Below is the outcome from the review and submit page. You will see the
     validation for each form and what is missing from the application that you
     need to complete. Red crosses indicate mandatory responses and
     information. Exclamation marks in a yellow circle indicate this is advisory to
     review but not mandatory.

     Review and Submit Information

     Page Name                                                                      Status         Your
                                                                                                   check

     Research Details                                                  X            Incomplete
     Project Title is required.                                              X
     Contracting Organisation is required.                                   X
     Proposed Start Date is required                                         X
     Research Duration (months) is required.                                 X
     How did you hear about this call response is required.                  X
     Research Type is required                                               X
     You have not entered a Total NHS Support & Treatment
     Costs/ (savings). Please review as needed
     You must confirm that you have read the NIHR Carbon                     X
     Reduction Guidelines.

     Contact Information                                                              Attention
     You have not provided a primary Web address. Please
     update as needed.

     Lead Applicant Details                                            X              Incomplete
     %FTE Commitment is required                                             X
     Are you on a fixed-term contract response is required                   X
     Do you currently hold an NIHR award? Response is                        X
     required.
     Do you require or currently hold a working permit or visa               X
     response is required.
     Do you wish us to contact you regarding this application                X
     response is required
     Role in research is required.                                           X
     Will you require an honorary contract to complete this work             X
     response is required.

     Curriculum Vitae                                                  X              Incomplete
     Are you a patient or public contributor response is                     X
     required.
     You responded that you are a patient or public contributor.
     Please enter details of any other relevant experience as

NETSCC Research Application Support. This is not a valid Application form
                                                                                                           Page 31 of 35
    NETSCC Application Support Form for FULL applications only
                           This is a template to assist with completing the form. It cannot be
                           submitted as a Word document as the application must be submitted
                           online. The content can be copied onto the online form however.
     needed.

     Research CV                                                                      Attention
     You have not entered any recent relevant publications.
     Please update as needed.
     You have not provided any Research Grants Held. Please
     update as needed.
     Research Team                                                                  Incomplete
     The Nominated Head of Department or Senior Manager is
     required.
     The Nominated Administrative Authority or Finance Office
     is required.
     The Sponsor is required.
     You have not provided an NHS Facilities and Staff
     Nominated Signatory. Please update as needed.
     You have not provided a Partner Organisations Facilities &
     Staff Nominated Signatory. Please update as needed.
     You have not entered any Co-Applicants. Please update
     as needed.

     PPI                                                                     X        Incomplete
     You responded yes that patients and the public were                     X
     actively involved in identifying the research topic and / or
     preparing the response. Details are required.
     Or You have not selected ways in which patients and the
     public will be actively involved in the proposed research.
     Please update as needed.
     You responded no that patients and the public were                      X
     actively involved in identifying the research topic and / or
     preparing the response. An explanation as to why this was
     not necessary is required.
     Were patients and the public actively involved in identifying           X
     the research topic or prioritising the research questions
     response is required.
     Were patients and the public actively involved in preparing             X
     this application response is required
     You have not selected ways in which patients and the                    X
     public will be actively involved in the proposed research.
     Please update as needed.

     History of Application                                            X              Incomplete
     You must select the relevance (Yes or No) for all                       X
     applications submitted to NETS Programmes
     You must state if this application or a similar application             X
     previously been submitted to this or any other funding
     body.

     Case for Support                                                  X            Incomplete
     Abstract (in plain English) is required.                                X
     Summary Of Research is required.                                        X
     Background & Rationale                                            X            Incomplete
     What is the problem being addressed response is                         X
     required.


NETSCC Research Application Support. This is not a valid Application form
                                                                                                   Page 32 of 35
    NETSCC Application Support Form for FULL applications only
                          This is a template to assist with completing the form. It cannot be
                          submitted as a Word document as the application must be submitted
                          online. The content can be copied onto the online form however.
     Why this research is important in terms of benefit to                  X
     patients and the NHS response is required.
     Evidence explaining why this research is needed now is                 X
     required.
     Aims and objectives are required.                                      X
     Changes from First Stage                                         X              Incomplete
     How has this changed from the first stage application                  X
     response is required.
     Dissemination & Output                                           X              Incomplete
     Description of plans for disseminating the findings of                 X
     research is required.
     Expected output of Research / Impact is required.                      X
     Relevant Expertise                                               X              Incomplete
     Strengths and contribution of each research team member                X
     is required.

     Justification of Costs                                           X              Incomplete
     A justification for the major sources of expenditure to this           X
     research is required.
     A justification for how the Research costs requested have              X
     been allocated is required.
     A justification for how the NHS Support and Treatment                  X
     costs requested have been allocated is required.

     Detailed Budget                                                  X            Incomplete
     The project budget must be greater than 0.                             X
     Management & Governance A                                        X            Incomplete
     Has any work relevant to this proposal already                         X
     commenced response is required
     Research Management Arrangements are required.                         X
     Research Timetable is required.                                        X
     Success Criteria and Barriers to Proposed Work is                      X
     required.
     You responded Yes to work for this proposal already                    X
     having commenced. Details are required.
     Is Clinical Trials Authorisation required response is                  X
     required.

     Management & Governance B                                        X            Incomplete
     Does the programme involve the administration of drugs,                X
     chemical agents or vaccines to the participants? Response
     is required.
     Does the proposed research raise ethical issues response               X
     is required.
     Is ethical approval required from a local research ethics              X
     committee response is required.
     Have any appropriate regulatory bodies already granted                 X
     the necessary approvals response is required.



NETSCC Research Application Support. This is not a valid Application form
                                                                                                  Page 33 of 35
    NETSCC Application Support Form for FULL applications only
                          This is a template to assist with completing the form. It cannot be
                          submitted as a Word document as the application must be submitted
                          online. The content can be copied onto the online form however.
     Research Plan                                                    X              Incomplete
     Address Feedback from First Stage is required.
     Additional Alterations is required.
     MeSH Terms is required.
     Design is required.
     Setting is required.
     Target Population is required.
     Inclusion/Exclusion Criteria is required.
     Health Technology is required.
     Control Treatment is required.
     Planned Interventions is required.
     Who will deliver the intervention? is required.
     Proposed Outcome Measures is required.
     Search Strategy is required.
     Review Strategy is required.
     Assessment and Follow Up is required.
     Sample Size is required.
     Statistical Analysis is required.
     Care Pathways in Comparative or Randomised Trials is
     required
     Difference between Current and Planned Care Pathways
     is required
     Intellectual Property                                             X             Incomplete
     You responded Yes to IP being produced or improved                     X
     during the proposed research. A description is required.
     You responded Yes to IP produced or improved. What are                 X
     the competitive devices, clinical practices or technologies
     already in use/near is required
     What relevant IP is held by the applicants and how does it             X
     relate to this application response is required.
     Has a full search for existing IP been conducted response              X
     is required.
     Is there any related or similar (background) IP that exists            X
     and what significance (impact) does it have to the
     applicants freedom to operate response is required.
     Will any IP be produced or improved during the proposed                X
     research response is required
     You responded Yes to IP being produced or improved                     X
     during the proposed research. A description of how any
     new IP generated through the proposed research will be
     managed or exploited is required.
     You responded Yes to IP being produced or improved                     X
     during the proposed research. A description of the benefits
     being provided is required.
     You responded Yes to IP being produced or improved.                    X
     Details of the key current downstream regulatory
     considerations or risks that need to be addressed for this
     technology is required

     Invention for Innovation i4i                                                    Attention
     You have not described what the market opportunities are.
     Please update if required
     Wider Context                                                    X             Incomplete
     You must state if this application will be supported by any             X
     other funding body.


NETSCC Research Application Support. This is not a valid Application form
                                                                                                  Page 34 of 35
    NETSCC Application Support Form for FULL applications only
                           This is a template to assist with completing the form. It cannot be
                           submitted as a Word document as the application must be submitted
                           online. The content can be copied onto the online form however.
     Is a Clinical Trials Unit involved with this research proposal          X
     response is required.
     You have not described the benefits identified from
     working with networks. Please review as needed.
     You have not described the role for any other NIHR
     organisations will have in this research. Please review as
     needed.
     You have not specified what other NIHR organisations will
     partner this research. Please review as needed
     You must indicate if any other NIHR organisations will                    X
     partner this research.
     You must indicate if you intend to link to NIHR Networks                 X
     Will NHS facilities, staff or patients be involved? is                   X
     required.
     Will facilities or staff from Partner organisations be                   X
     involved in the project? is required.

     DH Monitoring                                                      X            Incomplete
     Lead Applicant's Profession is required.                                X
     Is the Research Multi-Centre is required                                X
     Research Region is required                                             X
     You must select at least one UKCRC Health Category                      X
     You must select at least one UKCRC Research Activity                    X
     Code.
     Lead Applicant's Place of Work is required.                             X
     RDS Involvement                                                   X              Incomplete
     Did you contact the RDS response is required                            X
     Suggested Referees                                                               Incomplete
     You can provide at least two suggested referees to
     approach. (No validation)

     Uploads                                                           X            Incomplete
     Cover letter is required                                                X
     Detailed project description is required and has not been
     uploaded
     Project Plan is required and has not been uploaded
     (Please note this may be different depending on the
     research call that you are applying for)

     Acknowledgement                                                   X              Incomplete
     You have not confirmed the acknowledgement.                              X




NETSCC Research Application Support. This is not a valid Application form
                                                                                                   Page 35 of 35

								
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