Data Security Checklist for Principal Investigators by hsb18101


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									Additional Info:                                        MONTANA STATE UNIVERSITY-BOZEMAN                                                   PENDING # _______________
            Internal                                      PROPOSAL CLEARANCE FORM
            Earmark                                                                       7.08                                     $
OSP Use Only                                                                                 submission? *Y/N
                                                  Please Note: 2 PAGES                                                  Tracking #
                                                                                                          *Email confirmation REQUIRED - attach to PCF
1. Principal Investigator(s):
           First Name                       MI      Last Name                         Banner ID#      E-mail Address                                            Extension
Authorized Signature For Expenditures:                                                                                                        Banner ID #

2. Administering Department:
Dept. Name                                                                                                                                 Organization #
Dept. Contact Name                                                                                              E-Mail Address

3. Proposal Identification:                                                     Agency Solicitation # or Program Name:   (i.e.NSF 02-2):

Proposal Title:
Type of application:                              New
             (Check one)                          Continuation/Current #
                                                  Resubmitted/Orig PCF #
4. Agency Due Date                                                                    Agency name
                   Project Begin Date:                                                and address:
                    Project End Date:

5. Reviews/Certifications/Assurances
This proposal has been reviewed for IRB activity:                                                * MUST be initialed by dept head regardless of IRB activity
   (Department Head initials certify that all IRB requirements have been met according to MSU policies.)
Does this proposal involve any of the following activities: (If yes, certification signature must be obtained from the appropriate committee chair.)
                                                                                      NO / YES        Certification Signature                                   Date
Human Subjects (
Bio-Medical Animals (IACUC,
Agricultural Animals (AACUC)
Controlled Substances ( )
Radioactive Substances (
Recombinant DNA, Infectious Agents, Biological Toxins,
Select Agents (
Hazardous Materials (carcinogens, teratogens, mutagens, etc.)

6. Proposal Checklist
            Yes                           Will the project require renovations or modifications to current university facilities or additional new space? If yes,
            No                            please attach an explanation in detail to this form and obtain the approval of the Director of Facilities Services.
            Yes                           Do you as PI, any family member or any of the involved researchers or their family members, have any significant financial
            No                            interests (income of greater than $10,000/year when aggregated with family members, consulting agreements, management
                                          responsibilities or ownership interests of greater than $10,000 in value or greater than 5% ownership when aggregated with
                                          family members) that would reasonably appear to be affected by the Sponsored Research or in entities whose financial
                                          success would reasonably appear to be affected by the research. If yes, attach a Research Disclosure Statement. Legal
                                          Counsel will need to approve.

            Yes                           Are you as PI, or any of the involved researchers, aware of any restrictions on access to or publication of research
            No                            and technical data, limitations on the participation of foreign nationals in the research effort, or other security
                                          restrictions rendering exemption from export control regulations inapplicable. If yes, attach a detailed explanation.
                                          Legal Counsel will need to approve.
            Yes                           Is funding requested from a private foundation?
            Yes                           Will distance learning materials or software result from this work? If yes, the TTO Office will need to review.

                                          College of Agriculture only: MAES Project #                                                       Source Code
7. Funds Requested for Initial Budget Period: (Sponsor budget sheets with details must be attached)
Yr 1 Direct Costs                                                      Indirect Costs                                                    Total Costs
Indirect Costs calculated at:                      (check one)
                       % of                                            Modified Total Direct Costs
                                                                       Total Direct Costs
Funds Requested for All Budget Periods: (Complete only when more than one budget period is involved.)

Direct Costs                                                           Indirect Costs                                                    Total Costs

* If requesting waiver of part or all of Indirect Costs, please explain.                                   Location codes - no longer required. Contact your OSP
* If agency disallows Indirect Costs, please include agency                                                FM if you have any questions.
   policy statement.
* If cost sharing applies, section below must be complete.
* Does this proposal contain extra compensation? If so, is it
   detailed in your proposal?

                         COST SHARING

                              Amount               Index Number

  Other (Specify)
   Indirect Costs
  Total Matching

8. Proposal Approvals:
Principal Investigator certifies that the statements on this clearance form are true and complete to the best of his/her knowledge, and accepts the
obligation to comply with university policy and guidelines in conducting the research herein if a grant is awarded. The PI also certifies that he/she
is not delinquent on any federal debt.

PI and all Co-PIs Certifies the following: (1) the information submitted within the application is true, complete and accurate to the best of the PI's knowledge;
(2) any false, fictitious, or fraudulent statements or claims may subject PI to criminal, civil or administrative penalties; and (3) the PI agrees to accept
responsibility for the scientific conduct of the project and to provide the required progress rerports if a grant is awarded as a result of the application.

PI and all Co-Pis Certify they have read and will adhere to the MSU Electronic Data Security Policy.
Department Head: the department head's signature means that agreement has been reached regarding the amount and type of departmental
resources that will be committed to assist the PI in completing the project.

Overruns --- unresolved cost overruns on OSP projects will be covered from the Principal Investigators' and Departments'
share of indirect cost collections.

Dean's Office: The Dean's signature means that agreement has been reached regarding the amount of school or college resources committed to
support the program. The Dean's signature also ensures that a drug free workplace will be provided.

We have reviewed the proposal and concur that staff time of the individuals is available and that departmental or college resources including the
cost sharing obligations listed are committed in the event the project is funded.

Principal Investigator                                                 Date               Co-Principal Investigator                                       Date

Co-Principal Investigator                                              Date               Department Head                                                 Date

Dean                                                                   Date               Provost                                                         Date

VP for Administration*                                                 Date               VP for Research                                                 Date
*If MSU funds are required to match or maintain a program after its completion, and sponsor funding has ended, approval must be obtained from the VP for Administration.
9. Office of Sponsored Programs Final Approval and Disposition:

Budget Review                                                                             Date

VP for Research                                                                           Date

TTO Review                                                                                Date                                                                             7.08

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