Secondary Research Template

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					                RESEARCH BUDGET TEMPLATE – INTERNAL FUNDS
A financially successful study starts with a budget which accurately and completely captures all anticipated costs. Your involvement in
this process is critical. The template below will help prompt this process and ensure the appropriate items are included.

For Clinical Trials, please pay special attention to the Patient Care Cost section since these costs often are the majority of the budget,
and have a significant impact if not properly identified.

Form Instructions: On data entry, if it is necessary to add lines in a table or create more space in the document, go to “View,”
“Toolbars” and select “Forms” to make the Forms Toolbar visible. Then click on the “lock” symbol to unlock the form. Modify as
needed. In order to access URL’s you will need to unlock the form.


FUNDING PROPOSAL GENERAL INFORMATION
Full Title of Funding Proposal (for submission to funding source):
(NIH max is 81 characters including spaces)

PRINCIPAL INVESTIGATOR:
Proxies:

  Funding Organization Type:
  PI’s Institution (Internal)
  PI’s Institution/Development


Will we be secondary, e.g., will another institution be the primary recipient of the funding and pay us to do part of the
work?
   Yes      No

                                                             Primary Theme        Secondary Theme
           Mayo Thematic Research Category                   (choose only 1)      (choose only 1)
                                                                *required*
  Addictions Research
  Biomedical Technology
  Cancer
  Clinical & Translational Research
  Digestive Diseases
  Endocrine Diabetes Nutrition & Metabolic
  Genomics
  Heart, Lung and Blood
  Immunology
  Infectious Diseases
  Kidney and Urological Diseases
  Musculoskeletal Diseases
  Neurosciences
  Regenerative Medicine/Transplant
  Successful Aging
  Other

Will the Principal Investigator be the PI on all budgets related to this funding proposal?
   Yes       No

  Type of Proposal (please select only one)
  New
  Resubmission
  Renewal
  Revision
  Amendment
                                                                     1
  Supplement

Is Patient Consent required for any funded activities?
    Yes     No

Is this Funding activity Multicenter or Single Center?
     Multicenter
     Single Center

Is a product being provided by a company in addition to or in lieu of financial support?
    Yes     No

If yes, please list company name __________________________________________________________

ADDITIONAL PROPOSAL DETAILS
Internal Funding Type:
(Name the award.) Include a copy of the award announcement.
Date Project Starts

Number of Budget Periods requiring separate totals (enter integers only) (in other words, how many years should
this budget be built for?)
*Budget periods are typically one year in length, but can be any number of months


PROGRAM INCOME
Is program income anticipated during the period of grant support? Yes                   No
Some common examples include bur ar not limited to registration fees for workshops and conferences, sale of items fabricated or
generated under the project such as animal models, tissue cultures, cell lines, biospecimens, biological waste products, income from
fees for services performed under the poject such as fees for laboratory tests, use, sale or rental of real or personal property acquired
under the award.

If yes, provide Program Income Details:
Source:
Amount:
Period:


REVISION INFORMATION
  If this is a Revision, please select type
  Increase Award
  Decrease Award
  Increase Duration
  Decrease Duration
  Amendment
  Other (specify):


GRANT SUBMISSION *(required)
How will this application be sent to the Sponsor (Mayo internal committee)?
Electronically
Paper
Both

PUBLISHED APPLICATION DUE DATE:                          (internal deadline submission date)




                                                                     2
BUDGET CHARACTERISTICS
Will this project include the study of human subjects?
Yes         No

Will this project include animal studies?
Yes         No

Is this proposal related to an existing IACUC protocol? Yes               No
If Yes above, then the IACUC number:

Will an investigator at another research institution be paid from this budget? i.e.: will another institution be secondary to
us?
Yes        No

Will there be Cost Sharing, i.e., will Mayo be required to pay a portion of this budget? Yes           No
(Approval by the department is required before submission. Cost Sharing does not include salary above the NIH Salary Cap,)
Cost Share Reviewer:

Link to cost sharing information: http://mayocontent.mayo.edu/research-policy/MSS_640723
Link to cost sharing form: http://mayoweb.mayo.edu/researchforms/documents/cost-sharing-form.xls

If you answered yes to either question, please complete the Cost Sharing Form and obtain appropriate institutional
signatures. Your grant specialist can assist you in creating a cost sharing budget. The Cost Sharing Form must be
reviewed and approved by the Research Finance Subcommittee before application is sent to funding agency. NOTE: A
common example of cost sharing is stating more effort in your budget justification than stated in your budget,
e.g. budgeting for 5% effort for the PI and stating 10% effort in the budget justification.



HUMAN SUBJECTS INFORMATION
Is this proposal related to an existing IRB protocol?      Yes       No
If yes above, then the IRB number:

Will this be a clinical trial?        Yes   No

   Select Clinical Trial Phase
   Phase I
   Phase I/II
   Phase II
   Phase II/III
   Phase III
   Phase III/IV
   Phase IV

IRB EXEMPTION

IRB exempt?         Yes          No
If yes, enter IRB exemption number:


HUMAN SUBJECTS SCREENING / ENROLLMENT
Enter number of subjects you expect to screen each year, then enter the number of those you expect to enroll each year.
The number of 'screen failures' will be calculated for you. Please note any costs for the screen failures in your footnotes.

Participants                     Year 1     Year 2      Year 3        Year 4        Year 5        Totals
Screening Plan
Enrollment Plan
Screening Failures

                                                                 3
Human Subjects Screening/Enrollment Footnotes:


BUDGET ESTIMATE CONTACTS
   CTSA Estimate (formerly GCRC): website http://researchweb2.mayo.edu/researchresources/; Contacts: Jennifer Weis, Admin
    Manager 5-3294; Carol McAlister, Business Manager 6-0462
   Pharmacy Estimate: SMH Sandy Showalter 5-3182; RMH Mary Lempke 5-7912; Mayo Clinic Denise Harris 4-2021
   General Costs: May include services outside of Mayo such as page costs (publications), graphics, etc. Some areas are more
    likely to be used for research such as Animal maintenance http://mayoweb.mayo.edu/iacuc/, Mayo Core Facilities
    http://researchweb.mayo.edu/dept-groups-list.html, Engineering http://mayoweb.mayo.edu/doe/, Health Sciences Research
    (statistical costs) http://hsrwww.mayo.edu/cgi-
    bin/sasweb/broker?_service=default&_program=hsrrate.menu.sas&_debug=0&calc=initial
   Participant Recruitment: Leslie Jordan 5-1943 for assistance with advertising/recruitment plan & estimates
   Participant Remuneration: provide the amount participants will be paid and the frequency of payment – see the IRB policy manual
    at http://rweb00.mayo.edu/intranet/irb/policy_manual.cfm for guidance
   Participant Reimbursement: provide the amount of participant reimbursement for travel, lodging, parking, or meals


BUDGET



PERSONNEL COSTS (Mayo Clinic Staff Only)

List % effort or calendar months for each year.
First Name         Last Name      Role**                                         Year 1          Year 2          Year 3     Year 4
                                                                                 % Effort
                                       PRINCIPAL INVESTIGATOR




** if you indicate a “TBN” (to be named) individual such as a post doc, please indicate how many years experience post
degree we should base his/her salary on. If you name any other TBN individual, please let us know (if possible) the name
of someone currently in that role that you’d like his/her salary based upon.

*** Statisticians are not listed under “Personnel Costs” but instead under “Internal Services”.


PATIENT CARE COSTS

Study Teams find Mayo Procedure Codes on previous budgets or by calling the relevant labs to ask about the details and codes of tests.
In Rochester, Tim Benz at 8-9874 and Michelle Monosmith at 8-2264, both in Patient Financial Services, may also assist you.
Before you begin to determine which tests to include on the study budget, please review the IRB Manual at
http://rweb00.mayo.edu/intranet/irb/policy_manual.cfm for guidance. Very often tests and procedures that are done for screening
purposes and during the course of study participation are not clinically indicated and should be included in the study budget. Please
indicate below which tests and procedures are being done for screening purposes in addition to those that will be done for research
purposes during the course of study participation.
DSS                     Description      Purpose         Status                               Year 1 Year 2 Year 3 Year 4 Year 5
Procedure                                (Choose 1)
Code
                                            Research        Outpatient        Frequency/
                                           Std. Care        Inpatient         Patient
                                           CRU                                Patients/
                                         (GCRC)                               Year
                                            Research        Outpatient        Frequency/
                                           Std. Care        Inpatient         Patient
                                                                  4
                                                 CRU                                    Patients/
                                               (GCRC)                                   Year
                                                 Research              Outpatient       Frequency/
                                                 Std. Care             Inpatient        Patient
                                                 CRU                                    Patients/
                                               (GCRC)                                   Year
                                                 Research              Outpatient       Frequency/
                                                 Std. Care             Inpatient        Patient
                                                 CRU                                    Patients/
                                               (GCRC)                                   Year


SUPPLIES & EXTERNAL SERVICES

Item                                           Description             Year 1             Year 2             Year 3             Year 4             Year 5
Select one appropriate category:               Please provide          $                  $                  $                  $                  $
   Admin Costs                                 description of
   Books & Periodicals                         supply or
   Donor/ Volunteer                            external service:
   Payments
   Marketing
   Medical/Surgical/
   Lab Supplies
   Minor Equipment <$5000
   Miscellaneous
   Office & General Supplies
   Other Fees & Services
   Other Non-Medical Supplies
   Printing & Publications
   Telecommunications
   Tuition
(Use List Above)                                                       $                  $                  $                  $                  $

                                                                       $                  $                  $                  $                  $
                                                                       $                  $                  $                  $                  $
                                                                       $                  $                  $                  $                  $
                                                                       $                  $                  $                  $                  $




INTERNAL SERVICES

NOTES:
(1) All Core Facility charges should have indirects added.
(2 HSR / Statistician Personnel should be entered in this section. Describe how their costs were calculated, i.e., # of hours/period times $ per hour. If % FTE
is known instead of hours, divide percent by 100 and multiply by 1,456 hrs to get hours/yr, then multiply by $/hour to get $/year (HSR Website
http://hsrwww.mayo.edu/cgi-bin/sasweb/broker?_service=default&_program=hsrrate.menu.sas&_debug=0&calc=initial
(3) Indicate if you need a Statistical Programmer Analyst or a MS Statistician

IMPORTANT NOTE ABOUT CORE FACILITY INVOLVEMENT:
     If your proposal involves the use of existing core facilities, contact Carol Gorman in Research Administrative Services at Gorman.carol@mayo.edu
       or 6-4349.
     If you are expanding or creating a new core service with this proposal, this will require approval by the Core Oversight Committee. Please
       contact Carol Gorman in Research Administrative Services at Gorman.carol@mayo.edu or 6-4349.


Item                                           Description             Year 1            Year 2             Year 3            Year 4             Year 5
Select one appropriate category:               Please provide          $                 $                  $                 $                  $
                                               description of
   Admin Costs                                 internal service:
   Audio Visual
   Central Services
   Diagnostic Radiology Research
   Grant Indirects
   Immuno Chemical Core Lab

                                                                               5
   IRB Fees
   Med Statistics/Data Analyst –
indicate M.S. Statistician or
Statistical Analyst or Data Specialist
   Molecular Biology Core Facility
   Other Internal Fees & Services
   Pharmacy Charges
   Printing & Publications
   Protein Sequencing Lab
   Transgenic/Monoclonal Core
Facility

(Use List Above)                                            $              $                $             $               $

(Use List Above)                                            $              $                $             $               $

(Use List Above)                                            $              $                $             $               $


EQUIPMENT

Each item of equipment must be $5,000 or greater.
Item                               Description                        Year 1       Year 2        Year 3         Year 4        Year 5
   Building Improvements                                              $            $             $              $             $
   Equipment Purchases >=$5000
   Building Improvements                                              $            $             $              $             $
   Equipment Purchases >=$5000
   Building Improvements                                              $            $             $              $             $
   Equipment Purchases >=$5000



ANIMAL ORDERING COST

Animal           Cost/         Total Shipping Cost:                            Year 1       Year 2     Year 3       Year 4        Year 5
                 Animal        (transport + shipping
                               cages; Amount is not
                               multiplied)
                                                        # of Animals/
                                                        Period:
                                                        # of Animals/
                                                        Period:
                                                        # of Animals/
                                                        Period:
                                                        # of Animals/
                                                        Period:




ANIMAL MAINTENANCE COST

Study Teams find Mayo Procedure Codes on previous budgets or by calling the relevant labs to ask about the details and codes of tests.
In Rochester, Tim Benz at 8-9874 and Michelle Monosmith at 8-2264, both in Patient Financial Services, may also assist you.
Before you begin to determine which tests to include on the study budget, please review the IRB Manual at
http://rweb00.mayo.edu/intranet/irb/policy_manual.cfm for guidance. Very often tests and procedures that are done for screening
purposes and during the course of study participation are not clinically indicated and should be included in the study budget. Please
indicate below which tests and procedures are being done for screening purposes in addition to those that will be done for research
purposes during the course of study participation.
Animal Type Cage         Days/             #Animals/                               Year 1     Year 2       Year 3      Year 4     Year 5
                Cost/ Animal               cage
                Day



                                                                  6
# Animals/Period:
Cages Needed:
# Animals/Period:
Cages Needed:
# Animals/Period:
Cages Needed:
# Animals/Period:
Cages Needed:




        7
TRAVEL

Travel Costs     Foreign                                                      Year 1       Year 2     Year 3      Year 4       Year 5
(please          Travel?
describe
travel
needs)
                 Yes         Cost/Trip:
                 No          # of Trips/Period
                             # of People/Trip
                 Yes         Cost/Trip:
                 No          # of Trips/Period
                             # of People/Trip
                 Yes         Cost/Trip:
                 No          # of Trips/Period
                             # of People/Trip



CONSORTIUM/CONSULTANT

Will Mayo be      Primary, or     Secondary to another institution on the project?

Are other Mayo sites also involved on the project? Yes          No    . If Yes, which one(s)?

Institution      Investigator (please                                Year 1         Year 2       Year 3       Year 4       Year 5
(please be as    provide name, phone #, and
specific as      email)
possible)
                                                 Direct Costs
                                                 Indirect Costs
                                                 Direct Costs
                                                 Indirect Costs
                                                 Direct Costs
                                                 Indirect Costs



CONSULTANT COST

Consultant      Consultant      Consultant   Description        Year 1            Year 2         Year 3       Year 4        Year 5
  Name            Phone           E-mail
                                             $              $                 $              $            $            $
                                             $              $                 $              $            $            $
                                             $              $                 $              $            $            $




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