Preparing Budgets for Clinical Trial by lzt15136

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									  Form Approved Through 05/2004                                                                                                                OMB No. 0925-0001
                      Department of Health and Human Services                         LEAVE BLANK-FOR PHS USE ONLY.
                               Public Health Service                                  Type           Activity  Number
                         Grant Application                                            Review Group             Formerly
                          Follow instructions carefully.                              Council/Board (Month, Year)                Date Received
         Do not exceed 56-character length restrictions, including spaces.
1. TITLE OF PROJECT
        title
2. RESPONSE TO SPECIFIC REQUEST FOR APPLICATIONS OR PROGRAM ANNOUNCEMENT OR SOLICITATION                                                       x NO         x YES
(If "Yes," state number and title)
    Number:                        Title:
3. PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR                                           New Investigator              x     No x Yes
3a. NAME (Last, first, middle)                                                        3b. DEGREE(S)
      name                                                                                degree
3c. POSITION TITLE                                                                    3d. MAILING ADDRESS (Street, city, state, zip code)
   title
3e. DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT
   dept                                                                                        Mount Sinai School of Medicine
3f. MAJOR SUBDIVISION                                                                          One Gustave L. Levy Place
                School of Medicine                                                             New York, NY 10029-6574
3g. TELEPHONE AND FAX (Area code, number and extension)                               E-MAIL ADDRESS:
TEL:                          FAX:
                tel                               fax                                   e-mail
4.HUMAN SUBJECTS 4a. Research Exempt                    No        Yes                5. VERTEBRATE ANIMALS                   x No          x     Yes
  RESEARCH              If "Yes," Exemption no.    #
 x No                   4b. Human Subjects               4c. NIH-defined Phase III   5a. If "Yes," IACUC approval Date           5b. Animal welfare assurance no
 x Yes                  Assurance No.                         Clinical Trial
                           M-1155                            x No    x Yes                           x/x/xx                                    A3111-01
6. DATES OF PROPOSED PERIOD OF                          7. COSTS REQUESTED FOR INITIAL                        8. COSTS REQUESTED FOR PROPOSED
   SUPPORT (month, day, year-MM/DD/YY)                     BUDGET PERIOD                                         PERIOD OF SUPPORT
From                          Through                   7a. Direct Costs ($)         7b.Total Costs ($)       8a. Direct Costs ($)             8b. Total Costs ($)

      12/01/02                    11/30/07              0.                           0.                       0.                               0.
9. APPLICANT ORGANIZATION                                                            10. TYPE OF ORGANIZATION
Name      Mount Sinai School of Medicine                                                       Public:                 Federal         State        Local
Address One Gustave L. Levy Place, Box                         1075                            Private:         X      Private Nonprofit
                New York, NY 10029-6574                                                        Forprofit:              General         Small Business
                                                                                               Woman-owned:                 Socially and Economically Disadvantaged
                                                                                     11. ENTITY IDENTIFICATION NUMBER
                                                                                     1-136171197-A1
                                                                                     DUNS NO. (if available)
                                                                                     78861598
Institutional Profile Number (if known)                                                   Congressional District       14
12. ADMINISTRATIVE OFFICIAL TO BE NOTIFIED IF AWARD IS MADE                          13. OFFICIAL SIGNING FOR APPLICANT ORGANIZATION
Name      Ms. Jane Tsambis                                                           Name Ms. Jane Tsambis

Title           Associate Dean, Sponsored Programs                                   Title   Associate Dean, Sponsored Programs
Address         Grants and Contracts Office                                          Address Grants and Contracts Office
                Mount Sinai School of Medicine                                               Mount Sinai School of Medicine
                One Gustave L. Levy Place, Box 1075                                          One Gustave L. Levy Place, Box 1075
                New York, NY 10029-6574                                                      New York, NY 10029-6574
Tel             (212) 659-8970 FAX (212) 876-6789                                    Tel     (212) 659-8970         FAX (212) 876-6789
E-Mail          grants@mssm.edu                                                      E-Mail    grants@mssm.edu
14. PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR ASSURANCE: I certify that SIGNATURE OF PI/PD NAMED IN 3a.                                                        DATE
 the statements herein are true, complete and accurate to the best of my knowledge. I (In ink. "Per" signature not acceptable.)
 am aware that any false, fictitious, or fraudulent statements or claims may subject me
 to criminal, civil, or administrative penalties. I agree 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 this application.                                                                                                                    07/11/11
15. APPLICANT ORGANIZATION CERTIFICATION AND ACCEPTANCE: I certify that SIGNATURE OF OFFICIAL NAMED IN 13.                                                   DATE
 the statements herein are true, complete and accurate to the best of my knowledge, (In ink. "Per" signature not acceptable.)
 and accept the obligation to comply with Public Health Service terms and conditions if a
 grant is awarded as a result of this application. I am aware that any false, fictitious, or
 fraudulent statements or claims may subject me to criminal, civil, or administrative
 penalties.
                                                                                                                                                             07/11/11

  PHS 398 (Rev. 5/01)                                                           Face Page                                                                   Form Page 1
                                 Principal Investigator/Program Director (Last, first, middle):    name
                                                                                                   FROM           THROUGH
              DETAILED BUDGET FOR INITIAL BUDGET PERIOD
                          DIRECT COSTS ONLY                                                        12/01/02          11/30/03
PERSONNEL (Applicant organization only)                               %                           DOLLAR AMOUNT REQUESTED (omit cents)
                                                      TYPE         EFFORT       INST.
                                                      APPT.          ON         BASE
                                      ROLE ON                                  SALARY               SALARY      FRINGE
                                                     (months)       PROJ.
              NAME                    PROJECT                                                     REQUESTED    BENEFITS         TOTALS
                                    Principal
John Smith, Ph.D.                   Investigator        12           100                     0            0.             0.              0.
                                                        12           100                     0            0.             0.              0.
                                                        12           100                     0            0.             0.              0.
                                                                                             0            0.             0.              0.
                                                                                             0            0.             0.              0.
                                                                                             0            0.             0.              0.
                                                                                             0            0.             0.              0.
                                                                                             0            0.             0.              0.
                                   SUBTOTALS                                                              0.             0.              0.
CONSULTANT COSTS                    description                                                           0
                                    description                                                           0                              0.
EQUIPMENT (Itemize)                 description               0.            description                                  0.
description                                                   0.            description                                  0.
description                                                   0.            description                                  0.              0.
SUPPLIES (Itemize by category)                                0.            description                                  0.
description                                                   0.            description                                  0.
description                                                   0.            description                                  0.
description                                                   0.            description                                  0.
description                                                   0.            description                                  0.
description                                                   0.            description                                  0.
description                                                   0.            description                                  0.              0.
TRAVEL                              description                                                                          0.
                                    description                                                                          0.              0.
PATIENT CARE COSTS
                                    INPATIENT                                                                            0.              0.
                                    OUTPATIENT                                                                           0.              0.
ALTERATIONS AND RENOVATIONS (Itemize by category)                  description                                           0.
                                                                   description                                           0.              0.
OTHER EXPENSES (Itemize by category)                                        description                                  0.
description                                                   0.            description                                  0.
description                                                   0.            description                                  0.
description                                                   0.            description                                  0.
description                                                   0.            description                                  0.              0.
SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD                                                                      $                   0.
CONSORTIUM/CONTRACTUAL              DIRECT COSTS                                                                                         0.
COSTS                               FACILITIES AND ADMINISTRATION COSTS                                                                  0
TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Item 7a, Face Page)                                                    $                   0.
SBIR/STTR Only: FIXED FEE REQUESTED

  PHS 398 (Rev. 5/01)                                              Page                                                       Form Page 4
                                       Principal Investigator/Program Director (Last, first, middle):    name

                                       BUDGET FOR ENTIRE PROPOSED PROJECT PERIOD
                                                          DIRECT COSTS ONLY
                                   INITIAL BUDGET
                                       PERIOD                             ADDITIONAL YEARS OF SUPPORT REQUESTED
      BUDGET CATEGORY
            TOTALS                (from Form Page 4)             2nd                    3rd                    4th                    5th
PERSONNEL: Salary and fringe
 benefits
Applicant organization only                          0.                    0.                     0.                     0.                   0.
CONSULTANT COSTS
                                                     0.                    0.                     0.                     0.                   0.
EQUIPMENT
                                                     0.                    0.                     0.                     0.                   0.
SUPPLIES
                                                     0.                    0.                     0.                     0.                   0.
TRAVEL
                                                     0.                    0.                     0.                     0.                   0.
 PATIENT
  CARE
             INPATIENT                               0.                    0.                     0.                     0.                   0.
  COSTS      OUTPATIENT                              0.                    0.                     0.                     0.                   0.
ALTERATIONS AND
RENOVATIONS                                          0.                    0.                     0.                     0.                   0.
OTHER EXPENSES
                                                     0.                    0.                     0.                     0.                   0.
SUBTOTAL DIRECT COSTS
                                                     0.                    0.                     0.                     0.                   0.
CONSORTIUM/        DIRECT                            0.                    0.                     0.                     0.                   0.
CONTRACTUAL
COSTS               F&A                              0.                    0.                     0.                     0.                   0.
TOTAL DIRECT COSTS                                   0.                    0.                     0.                     0.                   0.
TOTAL DIRECT COSTS FOR ENTIRE PROPOSED PROJECT PERIOD (Item 8a, Face Page)
                                                                                                                                              0.
     SBIR/STTR Only:
   FIXED Fee Requested
SBIR/STTR Only: Total Fixed Fee Requested for Entire Proposed Phase II Period
(Add Total Fixed Fee amount to “Total direct costs for entire proposed project period” above and Total F&A/indirect costs from
  From Form Page, Entire Period: purchase asteriskequipment, Period of Support on Face Page, Item 8b.)
   For all Years:for and enter these
                                Identify with Requested (*) on this unusual justify any significant increase costs, alterations and
Checklist BudgetExplain and justify as “Costsanof major for Proposedpage and supplies requests, patient care or decrease in any category

JUSTIFICATION. Follow the budget justification instructions exactly. Use continuation pages as needed.




  PHS 398 (Rev. 5/01)                                                    Page                                                   Form Page 5
                                 Principal Investigator/Program Director (Last, first, middle):     name
                                         BUDGET JUSTIFICATION PAGE:
                                    MODULAR RESEARCH GRANT APPLICATION

Total Direct Costs for Entire Proposed Period of Support:

Initial Budget Period 2nd Year of Support   3rd Year of Support       4th Year of Support         5th Year of Support




Personnel
John Smith, Ph.D., Principal Investigator, (100% effort)
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, , (100% effort)
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, , (100% effort)
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, , (% effort)
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, , (% effort)
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, , (% effort)
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, , (% effort)
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, , (% effort)
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 PHS 398 (Rev. 5/01)                                           Page                                                 Modular Budget Format Page
                              Principal Investigator/Program Director (Last, first, middle):          name
                                                                            CHECKLIST
TYPE OF APPLICATION (Check all that apply.)

  X NEW application. (This application is being submitted to the PHS for the first time.)

                    SBIR Phase I                          STTR Phase II: SBIR Phase I Grant No. _            ______________________ SBIR Fast Track
                    STTR Phase I                          SBIR Phase II: STTR Phase I Grant No. _            ______________________SBIR Fast Track

     0 STTR Phase application number:
     REVISION of I 0 STTR Phase II: STTR Phase I Grant No. _             ______________________             0 STTR Fast Track
     (This application replaces a prior unfunded version of a new, competing continuation, or supplemental application.)
                                                                                  INVENTIONS AND PATENTS
                                                                                  (Competing continuation appl. And Phase II only)
     COMPETING CONTINUATION of grant number:                                                     No                      Previously reported
     (This application is to extend a funded grant beyond its current project period.)           Yes. If "Yes,"          Not previously reported

     SUPPLEMENT to grant number:
     (This application is for additional funds to supplement a currently funded grant.)


     CHANGE of principal investigator/program director.
     Name of former principal investigator/program director:
     FOREIGN application or significant foreign component.

1. PROGRAM INCOME (See instructions.)
All applications must indicate whether program income is anticipated during the period(s) for which grant support is requested. If program income is
anticipated, use the format below to reflect the amount and source(s).

           Budget Period                                  Anticipated Amount                                                  Source(s)
     N/A                                N/A                                                      N/A


2. ASSURANCES/CERTIFICATIONS
The following assurances/certifications are made and verified by the signature of the   •Debarment and Suspension; •Drug- Free Workplace (applicable to new [Type
Official Signing for Applicant Organization on the Face Page of the application.        1] or revised [Type 1] applications only); •Lobbying; •Non-Delinquency on
Descriptions of individual assurances/certifications are provided in Section III. If    Federal Debt; •Research Misconduct; •Civil Rights
unable to certify compliance where applicable, provide an explanation and place it      (Form HHS 441 or HHS 690); •Handicapped Individuals (Form HHS 641 or HHS
after this page.                                                                        690); •Sex Discrimination (Form HHS 639-A or HHS 690); •Age Discrimination
                                                                                        (Form HHS 680 or HHS 690); •Recombinant DNA and Human Gene Transfer
•Human Subjects; •Research Using Human Pluripotent Stem Cells• •Research on             Research; •Financial Conflict of Interest (except Phase I SBIR/STTR) •STTR
Transplantation of Human Fetal Tissue •Women and Minority Inclusion Policy              ONLY: Certification of Research Institution Participation.
•Inclusion of Children Policy• Vertebrate Animals•



3. FACILITIES AND ADMINISTRATION COSTS (F&A)/ INDIRECT COSTS. See specific instructions.

 X   DHHS Agreement dated:                                05/17/01                               No Indirect Costs Requested.

     DHHS Agreement being negotiated with                                                          Regional Office

     No DHHS Agreement, but rate established with                                                                 Date

CALCULATION* (The entire grant application, including the Checklist, will be reproduced and provided to peer reviewers as confidential information.
Supplying the following information on indirect costs is optional for forprofit organizations.)
a. Initial budget period:         Amount of base: $                    0    x   Rate applied             69.50       % = F&A costs $                             0
b. 02 year                        Amount of base: $                    0    x   Rate applied             69.50       % = F&A costs $                             0
c. 03 year                        Amount of base: $                    0    x   Rate applied             69.50       % = F&A costs $                             0
d. 04 year                        Amount of base: $                    0    x   Rate applied             69.50       % = F&A costs $                             0
e. 05 year                        Amount of base: $                    0    x   Rate applied             69.50       % = F&A costs $                             0
                                                                                                                  TOTAL F&A Costs $                              0
*Check appropriate box(es):
    Salary and wages base                             X   Modified total direct cost base                                Other base (Explain)
     Off-site, other special rate, or more than one rate involved (Explain)
Explanation (Attach separate sheet, if necessary.) :

4. SMOKE-FREE WORKPLACE                     X   Yes           No (The response to this question has no impact on the review or funding of this application.)


  PHS 398 (Rev. 5/01)                                                Page                                                                 Checklist Form Page
Internal Use Only:                                                                                                                      1/1/1904

                                                                                                                                        07/11/11
                                                                                                                                        ##########

MODULAR GRANT APPLICATION: CALCULATION WORKSHEET AND INSTRUCTIONS

"BASE" CALCULATIONS: Modified Total Direct Costs (MTDC)
1. INSTRUCTIONS FOR MODULAR GRANTS WITH CONSORTIUM/CONTRACTUAL COSTS
Skip to Step "2" if there are no subcontracts.
- Consortium/Contractual Costs are automatically rounded to the nearest $1,000 as per NIH instructions for calculating indirect costs on
  modular grants. The following "Consortium/Contractual Costs" figures below in dark blue are linked from the "EntireBudget-5" page.

Consortium/                       Year 1                   Year 2                 Year 3                    Year 4                 Year 5
Contract. Costs           Actual           Rounded      Actual Rounded        Actual      Rounded        Actual Rounded        Actual       Rounded
Direct                        0                 0          0        0             0             0            0           0         0                 0
F&A                           0                 0          0        0             0             0            0           0         0                 0
Total                         0                 0          0        0             0             0            0           0         0                 0



- Total Costs of Subcontracts Greater or Equal to $25,000 per Year: Subcontracting to One Institution
   If you are subcontracting to one institution and the combined total costs in the first year of the subcontracts are more $25,000, then you
  must enter exactly "25,000" in the "Plus Allowable Consortium/Contractual Costs" column below in the year the subcontract begins.
  Leave "0"s in all other years.
 Example: If you are subcontracting to an institution from years 1 to 5 and the total costs of the subcontract are $75,000 per year, you
  must enter "25,000" in year 1 in the "Plus Allowable Consortium/Contracutal Costs" column. Leave "0"s in years 2, 3, 4, and 5. Another
  example is if you have two subcontracts on a grant from the same institution from years 2 to 5, each worth $83,000 in total costs per
  year, enter "25,000" in year 2 only in the "Plus Allowable Consortium/Contractual Costs" column. Leave "0"s in years 1, 3, 4, and 5.
- Total Costs of Subcontracts Greater or Equal to $25,000 Per Year: Subcontracting to More than One Institution
   If you are subcontracting to more than one institution and the total costs in the first year of the subcontracts are more $25,000, then you
  must enter exactly "25,000" for each institution in the "Plus Allowable Consortium/Contractual Costs" column below in the year the
  subcontract begins. Leave "0"s in all other years.
  Example: If you are subcontracting to two institutions beginning in year 1 and ending in year 5 and the subcontract at Institution 1
  is $80,000 in total costs per year and the subcontract at Institution 2 is $95,000 in total costs per year, you must do the following.
 You must enter "50,000" (2 institutions x $25,000) in year 1 in the "Plus Allowable Consortium/Contracutal Costs" column. Leave "0"s in
  years 2, 3, 4, and 5.
- Total Costs of Subcontract(s) Less Than $25,000 Per Year: Subcontracting to One Institution
   If you are subcontracting to one institution and the combined total costs in the first year of the subcontracts are less than $25,000, then
  you must enter this combined total cost amount in the "Plus Allowable Consortium/Contractual Costs" column below in the year the subcontract
  begins. If the subcontract(s) continues for more than 1 year, the difference between the maximum cap of $25,000 and the combined total
  costs of the first year must be entered in the future years.
  Example: If you have a subcontract from years 2 to 4 with total costs of $17,000 per year, enter "17,000" in year 2 in the "Plus Allowable
  Consortium/Contractual Costs" column. The difference between $25,000 and $17,000 is $8,000. Therefore, in year 3, enter "8,000."
  Leave "0"s in Years 1, 4, and 5.
2. The "Total Direct" and "Less Equipment, Patient Care Costs, and Alter/Renovations" figures below in dark blue are linked from the
   "EntireBudget-5" page.
3. Equipment, Patient Care Costs, Alterations/Renovations, and Consortium/Contractual Costs are automatically excluded from MTDC.




                          Total    Total Direct                  Less                        Less                Plus Allowable            Modified
                          Direct     (MODULAR)            Equipment,                     Rounded                 Consortium/            Total Direct
                                                          Patient Care                 Consortium/               Contractual                       Cost
                                                           Costs, and                  Contractual               Costs                         Base
                                                     Alter/Renovations                      Costs                                           (MTDC)
          01YR                0                 0           -       0              -            0            +           0         =                 0
          02YR                0                 0           -       0              -            0            +           0         =                 0

                                                                     Page 6 of 19
          03YR                0               0              -           0               -              0             +        0             =         0
          04YR                0               0              -           0               -              0             +        0             =         0
          05YR                0               0              -           0               -              0             +        0             =         0
          Total               0               0              -           0               -              0             +        0             =         0


                  Total                                                                                     Remember! If the average
                  Direct                                                                     Modular        total direct costs per year is
                  Costs                                                      Avg. TDC        Amt. Per       greater than $250,000, then
                  (TDC)         /                 # of Years =               Per Year        Year           you should not be applying
                              0 /                    5           =               0               0          for a modular grant!




INDIRECT COST CALCULATIONS:
The following calculations are linked to the "Checklist" page.                                              Federal Agencies Rates
                                                                                                            On Site Research: 69.5%
      Modified Total Direct                         % RATE                    INDIRECT                      Off Site Research: 30.8%
         Cost Base (MTDC)                          APPLIED                      COSTS                       Training and Career Development: 8%



                              0       x               69.5%          =                  0 Default rate is set to 69.5%.
                              0       x               30.8%          =                  0 You must delete the "Total Base MTDC" amount in each
                              0       x                  8.0%        =                  0    69.5% calculation line if you are using the 30.8% or 8%
    01YR Total                0                                                         0    rates or any combination of the three.
                                                                                             Enter new Total Base MTDC amounts in the appropriate
                              0       x               69.5%          =                  0 indirect cost rate line for each year.
                              0       x               30.8%          =                  0
                              0       x                   8%         =                  0
    02YR Total                0                                                         0


                              0       x               69.5%          =                  0
                              0       x               30.8%          =                  0
                              0       x                   8%         =                  0
    03YR Total                0                                                         0


                              0       x               69.5%          =                  0
                              0       x               30.8%          =                  0
                              0       x                   8%         =                  0
    04YR Total                0                                                         0


                              0       x               69.5%          =                  0
                              0       x               30.8%          =                  0
                              0       x                   8%         =                  0
    05YR Total                0                                                         0


   Grand Total                0                                                         0


TOTAL COST CALCULATIONS:
These calculations are linked to the sheets, "Face-1" and "EntireBudget-5".


                           Total                         Total                  TOTAL
                       Direct                       Indirect                    COSTS
                   (Modular)
          01YR                0           +                 0        =                  0
          02YR                0           +                 0        =                  0
          03YR                0           +                 0        =                  0


                                                                         Page 7 of 19
04YR    0   +   0   =          0
05YR    0   +   0   =          0
Total   0   +   0   =          0




                        Page 8 of 19
not  (Attach separate sheet,
                 (See instructions,
Internal Use Only: if                                                                                                      1/1/1904

                                                                                                                           07/11/11

NON-MODULAR CALCULATION WORKSHEET AND INSTRUCTIONS                                                                         03:48:03 PM




"BASE" CALCULATIONS: Modified Total Direct Costs (MTDC)
The "Total Direct" and "Less Exclusions" figures in dark blue are linked from the "EntireBudget-5" page.


- Equipment, Patient Care Costs, Alterations/Renovations, and Consortium/Contractual Costs are automatically excluded from MTDC.

- Total Costs of Subcontracts Greater or Equal to $25,000 per Year: Subcontracting to One Institution
   If you are subcontracting to one institution and the combined total costs in the first year of the subcontracts are more $25,000, then you
 must enter exactly "25,000" in the "Plus Allowable Consortium/Contractual Costs" column in the year the subcontract begins. Leave "0"s
 in all other years.
 Example: If you are subcontracting to an institution from years 1 to 5 and the total costs of the subcontract are $75,000 per year, you
 must enter "25,000" in year 1 in the "Plus Allowable Consortium/Contracutal Costs" column. Leave "0"s in years 2, 3, 4, and 5. Another
 example is if you have two subcontracts on a grant from the same institution from years 2 to 5, each worth $83,000 in total costs per
 year, enter "25,000" in year 2 only in the "Plus Allowable Consortium/Contractual Costs" column. Leave "0"s in years 1, 3, 4, and 5.
- Total Costs of Subcontracts Greater or Equal to $25,000 Per Year: Subcontracting to More than One Institution
   If you are subcontracting to more than one institution and the total costs in the first year of the subcontracts are more $25,000, then you
 must enter exactly "25,000" for each institution in the "Plus Allowable Consortium/Contractual Costs" column in the year the subcontract
 begins. Leave "0"s in all other years.
 Example: If you are subcontracting to two institutions beginning in year 1 and ending in year 5 and the subcontract at Institution 1
 is $80,000 in total costs per year and the subcontract at Institution 2 is $95,000 in total costs per year, you must do the following.
 You must enter "50,000" (2 institutions x $25,000) in year 1 in the "Plus Allowable Consortium/Contracutal Costs" column. Leave "0"s in
 years 2, 3, 4, and 5.
- Total Costs of Subcontract(s) Less Than $25,000 Per Year: Subcontracting to One Institution
   If you are subcontracting to one institution and the combined total costs in the first year of the subcontracts are less than $25,000, then
  you must enter this combined total cost amount in the "Plus Allowable Consortium/Contractual Costs" column in the year the subcontract
  begins. If the subcontract(s) continues for more than 1 year, the difference between the maximum cap of $25,000 and the combined total
 costs of the first year must be entered in the future years.
 Example: If you have a subcontract from years 2 to 4 with total costs of $17,000 per year, enter "17,000" in year 2 in the "Plus Allowable
 Consortium/Contractual Costs" column. The difference between $25,000 and $17,000 is $8,000. Therefore, in year 3, enter "8,000."
 Leave "0"s in Years 1, 4, and 5.




                       Total                     Less               Plus Allowable            Total Base
                   Direct                 Exclusions                                           M
                                                                    Consortium/Contractual Costs TDC
                                                                    Costs
      01YR                0         -                0      +                0        =            0
      02YR                0         -                0      +                0        =            0
      03YR                0         -                0      +                0        =            0
      04YR                0         -                0      +                0        =            0
      05YR                0         -                0      +                0        =            0
       Total              0         -                0      +                0        =            0



INDIRECT COST CALCULATIONS:                                                      Federal Agencies Rates
The following calculations are linked to the "Checklist" page.                   On Site Research: 69.5%
                                                                                 Off Site Research: 30.8%
               Total Base           % RATE               INDIRECT                Training and Career Development: 8%
                   MTDC             APPLIED                COSTS
                       0     x        69.5%       =            0               Default rate is set to 69.5%.
                       0     x        30.8%       =            0               You must delete the "Total Base MTDC" amount in each
                       0     x         8.0%       =            0                69.5% calculation line if you are using the 30.8% or 8%
01YR Total             0                                       0                rates or any combination of the three.
                                                                               Enter new Total Base MTDC amounts in the appropriate
                       0     x        69.5%       =            0               indirect cost rate line for each year.
                       0     x        30.8%       =            0
                       0     x           8%       =            0
02YR Total             0                                       0


                       0     x        69.5%       =            0
                       0     x        30.8%       =            0
                       0     x           8%       =            0
03YR Total             0                                       0


                       0     x      69.50%        =            0
                       0     x        30.8%       =            0
                       0     x           8%       =            0
04YR Total             0                                       0


                       0     x      69.50%        =            0
                       0     x        30.8%       =            0
                       0     x           8%       =            0
05YR Total             0     x                                 0


Grand Total            0                                       0


TOTAL COST CALCULATIONS:
The "Total Direct" figures in dark blue are linked from the "EntireBudget-5" page.
These calculations are linked to "Face-1" page.


                    Total              Total              TOTAL
                   Direct           Indirect             COSTS
      01YR             0     +            0       =            0
      02YR             0     +            0       =            0
      03YR             0     +            0       =            0
      04YR             0     +            0       =            0
      05YR             0     +            0       =            0
       Total           0     +            0       =            0
Internal Use Only:                                                                                                                                 1/1/1904
                                                                                                                                                     07/11/11
SALARY CAP CALCULATIONS: YEARS 1-5                                                                                                                   3:48 PM


Users should not modify this sheet unless adding or deleting investigators or changing percent efforts from Years 2 to 5.
To change percent effort between years, delete the formula in the appropriate "Year 1 through Year 5 Total" section and replace with the modification.
"Base Salary" and "Percent Effort" data are linked from "Personnel" in "InitialBudget-4".
The "Total" amounts from Years 2 to 5 are linked to "Personnel" in "EntireBudget-5".


  NIH Salary Cap: $166,700
                                                                                      YEAR 1          YEAR 2         YEAR 3         YEAR 4         YEAR 5
     Base Salary    Percent      Fringe    Inflation      Salary        Fringe          Total           Total          Total          Total          Total
                     Effort       Rate       Rate      Requested       Amount
 1             $0    100.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 2             $0    100.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 3             $0    100.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 4             $0      0.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 5             $0      0.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 6             $0      0.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 7             $0      0.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 8             $0      0.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0


Total                                                                                      $0              $0             $0             $0              $0
                                 Principal Investigator/Program Director (Last, first, middle):    name
                                                                                                   FROM            THROUGH
             DETAILED BUDGET FOR INITIAL BUDGET PERIOD
                         DIRECT COSTS ONLY                                                         12/01/02           11/30/03
PERSONNEL (Applicant organization only)                                %                          DOLLAR AMOUNT REQUESTED (omit cents)
                                                        TYPE       EFFORT          INST.
                                                        APPT.        ON            BASE
                                        ROLE ON                                   SALARY            SALARY       FRINGE
                                                        (months)    PROJ.
               NAME                     PROJECT                                                   REQUESTED     BENEFITS        TOTALS
                                       Principal
John Smith, Ph.D.                      Investigator       12          100                    0             0.            0.              0.
                                                          12          100                    0             0.            0.              0.
                                                          12          100                    0             0.            0.              0.
                                                                                             0             0.            0.              0.
                                                                                             0             0.            0.              0.
                                                                                             0             0.            0.              0.
                                                                                             0             0.            0.              0.
                                                                                             0             0.            0.              0.
                                     SUBTOTALS                                                             0.            0.              0.
CONSULTANT COSTS                       *THESE AMOUNTS HAVE BEEN ADDED TO THE PERSONNEL
                                       SUBTOTALS ON THE PRECEDING BUDGET PAGE.
EQUIPMENT (Itemize)




SUPPLIES (Itemize by category)




TRAVEL


                                       INPATIENT
PATIENT CARE COSTS
                                       OUTPATIENT
ALTERATIONS AND RENOVATIONS (Itemize by category)


OTHER EXPENSES (Itemize by category)




SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD                                                                      $
CONSORTIUM/CONTRACTUAL                 DIRECT COSTS
COSTS                                  FACILITIES AND ADMINISTRATION COSTS

TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Item 7a, Face Page)                                                    $

SBIR/STTR Only: FIXED FEE REQUESTED

  PHS 398 (Rev. 5/01)                                  Page                                                                   Form Page 4
Number pages consecutively at the bottom throughout the application. Do not use suffixes such as 3a, 3b.
                                     Principal Investigator/Program Director (Last, first, middle):   name
                                          BUDGET JUSTIFICATION PAGE:
                                MODULAR RESEARCH GRANT APPLICATION (continued)



Personnel
John Smith, Ph.D., Principal Investigator, (100% effort)
define role on project by clicking in this text box. Adjust text box accordingly. Insert and delete rows to adjust page
formatting.

, , (100% effort)
define role on project by clicking in this text box. Adjust accordingly.



, , (100% effort)
define role on project by clicking in this text box. Adjust accordingly.



, , (% effort)
define role on project by clicking in this text box. Adjust accordingly.


, , (% effort)
define role on project by clicking in this text box. Adjust accordingly.


, , (% effort)
define role on project by clicking in this text box. Adjust accordingly.


, , (% effort)
define role on project by clicking in this text box. Adjust accordingly.



, , (% effort)
define role on project by clicking in this text box. Adjust accordingly.




  PHS 398 (Rev. 5/01)                                              Page                                      Modular Budget Format Page
Number pages consecutively at the bottom throughout the application. Do not use suffixes such as 3a, 3b.
Internal Use Only:                                                                                                                                 1/1/1904
                                                                                                                                                     07/11/11
SALARY CAP CALCULATIONS: YEARS 1-5                                                                                                                   3:48 PM
BUDGET PAGE 2

Users should not modify this sheet unless adding or deleting investigators or changing percent efforts from Years 2 to 5.
To change percent effort between years, delete the formula in the appropriate "Year 1 through Year 5 Total" section and replace with the modification.
"Base Salary" and "Percent Effort" data are linked from "Personnel" in "InitialBudget-4 (2)".
The "Total" amounts from Years 2 to 5 are linked to "Personnel" in "EntireBudget-5".


  NIH Salary Cap: $166,700
                                                                                      YEAR 1          YEAR 2         YEAR 3         YEAR 4         YEAR 5
     Base Salary    Percent      Fringe    Inflation      Salary        Fringe          Total           Total          Total          Total          Total
                     Effort       Rate       Rate      Requested       Amount

 1             $0    100.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 2             $0    100.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 3             $0    100.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 4             $0      0.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 5             $0      0.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 6             $0      0.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 7             $0      0.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0
 8             $0      0.00%     24.70%      3.00%              $0          $0             $0              $0             $0             $0              $0


Total                                                                                      $0              $0             $0             $0              $0
Internal Use Only:                                           1/1/1904
                                                              07/11/11
FRINGE BENEFITS RATE                                          3:48 PM
Users should not
change formulas or
calculations.

                                Year        Month   Index Fringe Rate
                                Jan. 1998   Jan        1         28.0
Start Index :          60                   Feb        2         28.0
End Index :            71                   Mar        3         28.0
                                            Apr        4         28.0
Rates Used :         F64..F75               May        5         28.0
                                            Jun        6         26.7
Average Rate :        24.70                 Jul        7         26.7
                                            Aug        8         26.7
                                            Sep        9         26.7
                                            Oct       10         26.7
                                            Nov       11         26.7
                                            Dec       12         26.7
                                Jan. 1999   Jan       13         26.7
                                            Feb       14         26.7
                                            Mar       15         26.7
                                            Apr       16         26.7
                                            May       17         26.7
                                            Jun       18         26.7
                                            Jul       19         26.7
                                            Aug       20         26.7
                                            Sep       21         26.7
                                            Oct       22         26.7
                                            Nov       23         26.7
                                            Dec       24         26.7
                                Jan. 2000   Jan       25         26.7
                                            Feb       26         26.7
                                            Mar       27         26.7
                                            Apr       28         26.7
                                            May       29         26.7
                                            Jun       30         26.7
                                            Jul       31         25.1
                                            Aug       32         25.1
                                            Sep       33         25.1
                                            Oct       34         25.1
                                            Nov       35         25.1
                                            Dec       36         25.1
                                Jan. 2001   Jan       37         25.1
                                            Feb       38         25.1
                                            Mar       39         25.1
                                            Apr       40         25.1
                                            May       41         25.1
            Jun   42   25.1
            Jul   43   24.7
            Aug   44   24.7
            Sep   45   24.7
            Oct   46   24.7
            Nov   47   24.7
            Dec   48   24.7
Jan. 2002   Jan   49   24.7
            Feb   50   24.7
            Mar   51   24.7
            Apr   52   24.7
            May   53   24.7
            Jun   54   24.7
            Jul   55   24.7
            Aug   56   24.7
            Sep   57   24.7
            Oct   58   24.7
            Nov   59   24.7
            Dec   60   24.7
Jan. 2003   Jan   61   24.7
            Feb   62   24.7
            Mar   63   24.7
            Apr   64   24.7
            May   65   24.7
            Jun   66   24.7
            Jul   67   24.7
            Aug   68   24.7
            Sep   69   24.7
            Oct   70   24.7
            Nov   71   24.7
            Dec   72   24.7
Jan. 2004   Jan   73   24.7
            Feb   74   24.7
            Mar   75   24.7
            Apr   76   24.7
            May   77   24.7
            Jun   78   24.7
            Jul   79   24.7
            Aug   80   24.7
            Sep   81   24.7
            Oct   82   24.7
            Nov   83   24.7
            Dec   84   24.7
Jan. 2005   Jan   85   24.7
            Feb   86   24.7
            Mar   87   24.7
            Apr   88   24.7
            May   89   24.7
            Jun   90   24.7
            Jul    91   24.7
            Aug    92   24.7
            Sep    93   24.7
            Oct    94   24.7
            Nov    95   24.7
            Dec    96   24.7
Jan. 2006   Jan    97   24.7
            Feb    98   24.7
            Mar    99   24.7
            Apr   100   24.7
            May   101   24.7
            Jun   102   24.7
            Jul   103   24.7
            Aug   104   24.7
            Sep   105   24.7
            Oct   106   24.7
            Nov   107   24.7
            Dec   108   24.7
Jan. 2007   Jan   109   24.7
            Feb   110   24.7
            Mar   111   24.7
            Apr   112   24.7
            May   113   24.7
            Jun   114   24.7
            Jul   115   24.7
            Aug   116   24.7
            Sep   117   24.7
            Oct   118   24.7
            Nov   119   24.7
            Dec   120   24.7
Jan. 2008   Jan   121   24.7
            Feb   122   24.7
            Mar   123   24.7
            Apr   124   24.7
            May   125   24.7
            Jun   126   24.7
            Jul   127   24.7
            Aug   128   24.7
            Sep   129   24.7
            Oct   130   24.7
            Nov   131   24.7
            Dec   132   24.7
Jan. 2009   Jan   133   24.7
            Feb   134   24.7
            Mar   135   24.7
            Apr   136   24.7
            May   137   24.7
            Jun   138   24.7
            Jul   139   24.7
            Aug   140   24.7
            Sep   141   24.7
            Oct   142   24.7
            Nov   143   24.7
            Dec   144   24.7
Jan. 2010   Jan   145   24.7
            Feb   146   24.7
            Mar   147   24.7
            Apr   148   24.7
            May   149   24.7
            Jun   150   24.7
            Jul   151   24.7
            Aug   152   24.7
            Sep   153   24.7
            Oct   154   24.7
            Nov   155   24.7
            Dec   156   24.7

								
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