NIHR CSO HCS RND 3 2012 FINANCE FORM

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					FINANCE FORM FOR NIHR TCC                            NIHR CSO HEALTHCARE SCIENCE POST-DOCTORAL/DOCTORAL FELLOWSHIP
Details of Proposed Fellowship
Applicant Name:
Start Date:
% FTE                                                Please select

Duration (months):

Select Employing/Host Organisation Type              Select from list




Details of Support Requested

To be costed at current prices

Direct Costs (include directly allocated)            Expenditure that is to be directly incurred for the fellowship and only this fellowship and is supported by an auditable record


Staff

                                                      Employing            Role            Grade       Starting point     Increment       Basic Salary    Geographical         Other        National   Superannuation     Current
Details of Posts and Salaries
                                                      organisation                                       on scale            Date                          Weighting        allowances     Insurance                    Annual Costs
                                                                                                                                                £              £                 £              £            £               £
Applicant
Current                                                                                                                                                                                                                          -
Proposed                                                                                                                                                                                                                         -
Shared staff
                                                                                                                                                                                                                                 -
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Annual costs of posts                                % Full-time on Total months on       Year 1           Year 2           Year 3           Year 4           Year 5           Total
                                                     this Research this Research            £                £                £                £                £                £

Applicant
Basic Salary                                          Please select                                                                                                                    -
National Insurance                                                                                                                                                                     -
Superannuation                                                                                                                                                                         -
Geographical weighting (if applicable)                                                                                                                                                 -
Total Applicant Salary                                                                             -                -                -                -                -               -
Shared Staff (previously under directly allocated)
                                                                                                                                                                                   -
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Total Shared Staff                                                                              -                   -             -                -                -              -
                                                                                          Year 1           Year 2           Year 3           Year 4           Year 5          TOTAL
Total Annual Costs of Posts
                                                                                            £                £                £                £                £               £
                                                                      GRAND TOTAL               -                   -             -                -                -              -
Travel, Subsistence and Conference Fees

                                                                                       Year 1        Year 2        Year 3        Year 4        Year 5         Total       Type of cost
Description
                                                                                          £             £             £             £             £             £
Journey Costs
                                                                                                                                                                      -   Please select
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TOTALS:                                                                                         -             -             -             -             -             -
Subsistence
                                                                                                                                                                      -   Please select
                                                                                                                                                                      -   Please select
                                                                                                                                                                      -   Please select
                                                                                                                                                                      -   Please select
                                                                                                                                                                      -   Please select
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TOTALS:                                                                                         -             -             -             -             -             -
Conference Fees
                                                                                                                                                                      -   Please select
                                                                                                                                                                      -   Please select
                                                                                                                                                                      -   Please select
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                                                                                                                                                                      -   Please select
TOTALS:                                                                                         -             -             -             -             -             -


Total Travel, Subsistence and Conference Fees costs                                             -             -             -             -             -             -



Equipment

                                                           Price      Expected life     Year 1        Year 2        Year 3        Year 4        Year 5         Total       VAT cannot      Total
Description                                           excluding VAT   time (months)   £ (ex-VAT)    £ (ex-VAT)    £ (ex-VAT)    £ (ex-VAT)    £ (ex-VAT)    £ (ex-VAT)    be reclaimed /    £
                                                             £                                                                                                              VAT relief
                                                                                                                                                                              applied
                                                                                                                                                                      -    Please select           -
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                                                                                                                                                                      -    Please select           -
Total Equipment Costs                                                                           -             -             -             -             -             -                            -
Consumables

                                            Year 1       Year 2       Year 3       Year 4       Year 5       Total
Description
                                              £            £            £            £            £            £
                                                                                                                     -
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Total Consumables Costs                              -            -            -            -            -           -


Patient and Public Involvement

                                            Year 1       Year 2       Year 3       Year 4       Year 5       Total
Description
                                              £            £            £            £            £            £
                                                                                                                     -
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Total Public and Public Involvement Costs            -            -            -            -            -           -



Other Direct Costs

                                            Year 1       Year 2       Year 3       Year 4       Year 5       Total
Description
                                              £            £            £            £            £            £
                                                                                                                     -
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Total Other Direct Costs                             -            -            -            -            -           -
Patent and Legal

                                            Year 1       Year 2       Year 3       Year 4       Year 5       Total
Patent and legal description
                                              £            £            £            £            £            £
                                                                                                                     -
                                                                                                                     -
                                                                                                                     -
                                                                                                                     -
                                                                                                                     -
                                                                                                                     -
Total Patent and Legal Costs                         -            -            -            -            -           -


Training and Development

                                            Year 1       Year 2       Year 3       Year 4       Year 5       Total
Description
                                              £            £            £            £            £            £
Applicant PhD Tuition Fees (DOCTORAL FELLOWSHIP ONLY)
                                                                                                                                                -
TOTALS                                                                       -            -            -            -             -             -
Short Courses
                                                                                                                                                -
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TOTALS                                                                       -            -            -            -             -             -
Workshops
                                                                                                                                                -
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                                                                                                                                                -
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TOTALS                                                                       -            -            -            -             -             -
Overseas Research Visits
                                                                                                                                                -
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TOTALS                                                                       -            -            -            -             -             -

Total Training and Development Costs                                         -            -            -            -             -             -


SUMMARY TABLES                                          Travel       Equipment    Consumables    PPI       Other Direct   Patent and   Training and
                                                                      (inc VAT)                               Costs          Legal     development
                                                                 -            -           -            -             -             -             -



                                                                     Year 1        Year 2       Year 3      Year 4        Year 5        TOTAL
TOTAL DIRECT COSTS                                                       -             -            -           -             -            -
NHS Support and Treatment costs (including excess treatment Costs/(Savings))

For advice on this section please contact NIHR TCC

Please note that a justification for these costs must be clearly provided in your detailed project description. Please also note that any award will not include NHS Support costs or
NHS Excess Treatment Costs/(Savings).

In addition to the guidance that accompanies this form, applicants should also read the document HSG(97)32 and other Department of Health guidance on attributing the costs of
non-commercial research that can be found on the DH website at
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthserviceguidelines/DH_4018353

NHS Support Costs

                                                                                                         Cost per          Year 1          Year 2           Year 3          Year 4       Year 5       Overall Total
Description of expected additional procedures/resource requirements                                       patient
                                                                                                             £               £                £               £                £             £             £
                                                                                                                                                                                                                -
                                                                                                                                                                                                                -
                                                                                                                                                                                                                -
                                                                                                                                                                                                                -
                                                                                                                                                                                                                -
Total NHS Support Costs                                                                                           -                 -               -                -               -            -             -

                                  Have you discussed and agreed these costs with                            Yes              No
                                                              The Lead Network




Estimated Treatment Costs (including Excess Treatment Costs/(Savings))

Provide an estimate of the treatment costs involved in the research (and which would continue assuming that the patient care service in question continued after the research activity has
stopped), along with the costs of the usual standard treatmetn of the condition. these costs should be determined in conjunction with your NHS Trust partner(s) and their commissioners



NHS Treatment Costs                                                                                      Cost per          Year 1          Year 2           Year 3          Year 4       Year 5       Overall Total
Description of expected resources required or released                                                    patient
                                                                                                             £               £                £               £                £             £             £
                                                                                                                                                                                                                -
                                                                                                                                                                                                                -
                                                                                                                                                                                                                -
                                                                                                                                                                                                                -
                                                                                                                                                                                                                -
Total NHS Treatment Costs                                                                                         -                 -               -                -               -            -             -


                               Have you discussed and agreed the NHS costs with                             Yes              No
                                                                 The Lead Trust


  Is the patient care being provided different from the usual standard treatment for                        Yes              No
                                                                      the condition?
                               If yes, detail the costs of usual standard care below:
Usual treatment costs                                                                                   Cost per           Year 1          Year 2          Year 3        Year 4       Year 5        Overall Total
Description of expected resources required or released                                                   patient
                                                                                                            £                 £               £              £              £           £                £
                                                                                                                                                                                                              -
                                                                                                                                                                                                              -
                                                                                                                                                                                                              -
                                                                                                                                                                                                              -
                                                                                                                                                                                                              -
Total Usual Treatment Costs                                                                                     -                   -               -               -             -             -             -

Excess Treatment Costs1 / Savings                                                                               -                   -               -               -             -             -             -
1
Treatment costs that are less than the standard costs are savings and will be shown as a negative amount.




Summary of Costs
Please note that all fields on this page are completed automatically based on information entered in other sections.




RESEARCH COSTS REQUESTED FROM FUNDER

                                                                                                                       Indirect costs/                   % of costs      Amount
                                                                                                       Direct costs                      Total Costs
                                                                                                                         Overheads                      paid by NIHR    requested

TOTAL NHS RESEARCH COSTS                                                                                        -                                   -      100%                   -




                              TOTAL RESEARCH COSTS REQUESTED FROM FUNDER                                                                                                                    -




NHS SUPPORT AND TREATMENT COSTS/(SAVINGS)

NHS Support Costs requested from networks                                                       -
NHS Treatment Costs / (savings) requested from the NHS                                          -
TOTAL NHS SUPPORT AND TREATMENT COSTS/SAVINGS)                                                  -


TOTAL COST OF RESEARCH

RESEARCH COSTS                                                                                  -
NHS SUPPORT AND TREATMENT COSTS/(SAVINGS)                                                       -
TOTAL FUNDING REQUIRED                                                                          -
Select from list   Dropdown for cost description        1   Please select
NHS                                                     2       100%
                                                        3        75%
                                                                 60%
                                                                 50%




NHS 1              HEI 1                 Commercial 1
NHS 2              HEI 2                 Commercial 2
NHS 3              HEI 3                 Commercial 3
NHS 4              HEI 4                 Other 1
NHS 5              HEI 5                 Other 2
NHS 6              HEI 6                 Other 3
Please select   Please select
Yes             Conference
No              Other

				
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