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					UNIVERSITY OF VIRGINIA INTERNAL PROPOSAL APPROVAL FORM FOR NIH E-SNAP SUBMISSIONS ONLY
School Proposal # Principal Investigator Name: Project Number Project Owning Org # Sponsor Name Title of Project Proposal Period From: to Summary of Costs for Proposal Period: National Institutes of Health (NIH) School/Dept. Name: PI Email: Award Number Award Owning Org # Proposal Type Continuation

Direct Costs Indirect Costs Total Sponsor Costs Cost Sharing Total Budget Cost % Cost Sharing

Sponsor Deadline:

Dept Deadline:

PRINCIPAL INVESTIGATOR / PROGRAM DIRECTOR'S STATEMENT 1. A) B) 2. 3. i) Does the proposal involve human subjects? If yes, attach IRB approval or explain. ii) If the proposal involves human subjects, does it also involve human fetal tissue? If yes, attach IRB approval or explain. If the answer to 1. A) is YES, have all key personnel completed UVa's on-line HIC training module http://www.med.virginia.edu/HIC/ ? For additional information, refer to http://www.virginia.edu/~sponpgm/hicrelease.htm Will the proposal involve the use of radioactive materials? Will the proposal involve the generation of hazardous chemical waste? Has the Office of Environmental Health and Safety been notified if the answer to A or B above is Yes?

YES

NO

NA

Will animals be required? If yes, attach approved protocol or explain. A) B) C) D)

4.

Will the proposal involve the use of human-derived materials, infection micro-organisms, recombinant DNA or biological toxins? Note: Institutional Biosafety Committee (IBC) registration is required PRIOR to use of any of these materials. Please provide approval number if you have one. If you do not have an IBC approval number, you may initiate the approval process by completing an Online IBC Registration Form. Has there been a change in the financial interests of you, other program personnel, and/or relevant family members since the last award budget period in the sponsoring organization to which this proposal is being submitted. If YES, explain on page two of this form. For assistance, refer to UVa Objectivity in Research Policy information at the following websites: http://www.virginia.edu/researchandpublicservice/research/researchpol/objectivity.html and http://www.virginia.edu/researchandpublicservice/research/researchcom/researchcom.html

5. 6. 7.

Have all professional staff involved in the proposed project signed the University Patent Agreement? If NO or uncertain, contact the Office of the Vice President for Research and Public Service to verify. Are there any project personnel presently debarred, suspended, or proposed for debarment by any Federal agency? If YES, the proposal should include an explanation. Is there any implied release time from teaching activities? If yes, attach explanation.

By signing below, the PI makes the following certifications: (1) that the information submitted within the application is true, complete and accurate to the best of the PI's knowledge; (2) that any false, fictitious, or fraudulent statements or claims may subject the PI to criminal, civil, or administrative penalties; and (3) that the PI agrees to accept responsibility for the scientific conduct of the project and to provide the required progress reports if a grant is awarded as a result of the application. PI Signature: Date:

DEPARTMENT CHAIR'S AND DEAN'S STATEMENTS: Except as noted below, we concur with the submission of this proposal, which is consistent with the education and research objectives of the Department and School, and agree: 1. 2. 3. 4. To release the designated faculty for the effort indicated. That cost sharing is reasonable and appropriate for this program. That adequate space will be made available for the proposed program. That in the event of a sponsor refusing to pay due to a non-performance or default, the department will be responsible for any outstanding financial obligations (F&A recoveries will be backed off non-paid expenses.) Date: Date:

Department Chair Signature: Dean of School Signature: Comments: APPROVED FOR THE UNIVERSITY OF VIRGINIA BY:
Form SP-23E OSP (Revised 04.14.06)

Date:
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UNIVERSITY OF VIRGINIA INTERNAL PROPOSAL APPROVAL FORM FOR NIH E-SNAP SUBMISSIONS ONLY
PART TWO INFORMATION FOR CENTRAL ADMINISTRATOR USE IN REVIEWING PROPOSALS 1. Attach internal budget showing anticipated expenditure of next year’s funding. Explain any deviation from UVA’s approved fringe benefits rates and salary (or wage) rates for faculty, staff and students below.
YES NO NA

2.

Have central service rates been verified as current? Attach rate documentation. If “no,” explain. Does the budget include cost items subject to CAS not previously approved? If “yes,” complete and attach Part Three of this form. Does the budget include cost sharing not previously disclosed? If “yes,” complete Part Four of this form. Have the necessary clearances been obtained from participating departments or schools? If "no", explain below Are there any graduate students paid $5,000 or more in a year? If the response to 6. is “yes,” is tuition remission (or in-state equivalent)/health insurance included? . Does the proposal include a subcontract? SNAP QUESTIONS WITH GUIDANCE NOTES

3.

4. 5.

6. 7. 8.



Has there been a change in the other support of key personnel since the last reporting period? Answer “yes” if there has been a change in active support of key personnel only. If “yes” provide a complete, annotated Other Support statement indicating what has changed since the prior budget period.



Will there be, in the next budget period, a significant change in the level of effort of the PI or other personnel designated in the Notice of Grant Award from what was approved for the project? A significant change is defined as a 25% or greater reduction of effort. If the answer is “yes” then an explanation is necessary.



Is it anticipated that an estimated unobligated balance (including prior year carryover) will be greater than 25 percent of the current year’s budget? If “yes,” an explanation as to why the balance exists is required.

Explanatory Notes:

A review has been made to insure that University Procedures for preparing proposals have been considered and the aboverequired actions have been taken. Research Administrator Signature: Date:

Form SP-23E OSP (Revised 04.14.06)

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UNIVERSITY OF VIRGINIA INTERNAL PROPOSAL APPROVAL FORM FOR NIH E-SNAP SUBMISSIONS ONLY

PART THREE JUSTIFICATION FOR COST ACCOUNTING STANDARDS EXCEPTION REQUEST

I. For all Facilities and Administrative (indirect) budget items you are requesting to treat as direct charges on a Federal grant or an award with any federal flow through dollars, provide justification demonstrating how the unique nature of the grant validates the cost being directly charged. Include justification for each budget item. Refer to UVA Policy VIII.A.8 and VIII.A.6 at http://www.virginia.edu/%7epolproc/pol/poltoc.html#sectionVIII and UVA’s Cost Accounting Standards guidelines at http://www.virginia.edu/~sponpgm/casguidelines.htm for further explanation. If sufficient space for explanation is not available on this form, please continue on a standard sheet and attach additional documentation as needed. Signatory approvals from the Principal Investigator and Department Chair are required below.

Budget Item

Justification

II. Transaction Controls: Oracle Transaction Controls have been implemented to assist with financial grants management. Below is a list of expenditure types for which transaction controls have been set. If completing the above justification, you must also check the appropriate box below. NOTE: The list below is not exhaustive. These are merely items for which CAS exceptions and exemptions are most commonly requested. If you wish to charge other items which are typically considered an indirect (F&A) cost, please check the “Other” box, add the expenditure type and provide an explanation above. Eq Capital Voice & Data Eq Non-Capital Library Eq Non-Capital Office Furniture Eq Non-Capital Voice & Data Administrative Faculty Salaries Supplies, Educational Supplies, Office Other (Specify expenditure type in section 1. above) Eq Non-Capital Desktop Comp Eq Non-Capital Mobile Comp Eq Non-Capital Other Comp Equ Eq Library Books Supplies, Computer Operating Supplies, Food Svc Faculty Salary (TRAINING GRANTS AND FELLOWSHIPS ONLY) Svcs, U.S. Postal

III. For any administrative/clerical staff compensation costs you are requesting to be treated as direct charges, include the employee's name, position title, whether or not they are currently working in this administrative capacity, and a copy of their job description. [If OSP already has this specific job description on file from a previous proposal and there is no substantive change in duties, an additional job description is not necessary; simply mention that a job description has already been provided.] In addition, attach a written justification describing how the administrative position qualifies as an unlike circumstance.

Employee Name

Position Title

Currently in this Capacity? yes no yes no yes no

Job Description Attached? yes sent previously yes sent previously yes sent previously

Principal Investigator Name: Principal Investigator Signature: Chair Signature: OSP Approval Signature

Department/School: Date: Date: Date:

Approval by the University on the use of these exceptions does not preclude the federal agency from disallowing these costs in an audit.
Form SP-23E OSP (Revised 04.14.06) 3

UNIVERSITY OF VIRGINIA INTERNAL PROPOSAL APPROVAL FORM FOR NIH E-SNAP SUBMISSIONS ONLY

PART FOUR BUDGETED COST SHARING

PART FOUR – COST SHARE COMMITTED IN PROPOSAL (Complete one form for each year of cost share, unless there are no variations) PI Name: _________________ PI Department/School:

For OSP Use:

__________________
Project/Award Number

____________________ Is Cost Share Mandatory __

__ Voluntary _

__?

A. Salary and Wage Detail (contributed effort)
Fill out this section of the form if you are including any salary/wage cost share in your proposal budget. Exclude salary cap information on this form. Name Employee Employee Type (Check one) % Cost Salary/Wages Number Share Effort ($) 9 mo. 12 mo. SOM Classified Student Faculty Faculty Faculty

Total

B. Other Than Personnel Services (OTPS) Type of Cost Share Source of Cost Share (Award number only) Amount of Cost Share ($)

Fringe Benefits Equipment (describe) Unrecovered Facilities & Administrative Costs Other (please explain)
Total

This form commits your department/school to funding the cost share listed above from sources other than this grant or any federal grant. Department Chair Signature: _________________________________________________ Date: _______ (required for commitment of department resources) Dean of School Signature: ____________________________________________________ Date: ________ ________

________

(required for commitment of school resources)

Form SP-23E OSP (Revised 04.14.06)

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