Proposal Intake Form SEP 2017

SPA

Use

Date Received PC Assignment

Proposal Number Negotiation Number

Institutional Proposal Proposal Type: Activity Type: Project Title:

Lead Unit: (e.g. 1-681000/SPA)

Sponsor & Program InformationSponsor Name: Prime Sponsor Name: Sponsor Proposal ID: Sponsor Deadline Date: Sponsor Deadline Time (CT): Sponsor Deadline Type: Notice of Opportunity: This proposal includes subaward(s)?: CFDA Number: Opportunity Number: Guidelines URL:

Account Info Proposal Number (Resubmission) or Grant Code (Supplement):

Project PersonnelName UIN or NetID Project Role

Unit Contact InformationName NetID or Group Email Address

Submission Information Type: Address:

This proposal is related to an Award that SPA has already received or will draft:

Project Periods and Amounts Indirect Cost Rate Initial Period Total

Start Date: End Date:

Direct Cost:

Rate: Basis: Location: Explanation: If Basis is “Other”, then please explain:

F&A Cost: Total Cost:

Proposal Intake Form SEP 2017

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Special Review (Regulatory Compliance)

Approval Status Protocol Number Approval

Date Comments Animal Subjects Biological Safety Export Control Human Subjects

Chemical Hazards Investigator COI Laser or X-Ray Equip. Sponsor-Specific COI

Additional Proposal Documents In addition to this Proposal Intake Form, SPA must receive all proposal documents required by the sponsor to request funding. These proposal documents should include everything requested by the proposal call, but, at a minimum, should include or incorporate the following: (1) Statement of Work, (2) Budget, and (3) Budget Justification.

Project Characteristics Cost Exception (Admin. Costs) Approval: Cost Sharing Type: F&A Waiver Request Approval: Graduate College (Fellowship) Approval: Limited Submission Approval: PI Eligibility (Non-Tenure Track PI) Project Approval: Blanket Approval (on file): Tuition Remission Waiver Request Approval:

HIPAA International Programs Program Income Anticipated Proprietary / Confidential Project SBIR/STTR Solicitation Small Biz Subcontracting Plan Special F&A Distribution Distribution Code (if known): US Govt Classified or Restricted

Proposal Intake Form SEP 2017

Proposal Certification(s) Researcher Certification: My signature below certifies that (1) the information submitted herein is true, complete and accurate to the best of your knowledge, (2) any false, fictitious, or fraudulent statements or claims may subject you to criminal, civil or administrative penalties, (3) you agree to accept responsibility for the scientific conduct of the project and to provide progress reports, (4) you are current in your disclosures of known significant financial and/or familial conflicts that might reasonably appear to be affected by the proposed research, and (5) when required under sponsor regulation, you further ensure that you are current in such disclosures of known significant financial and/or familial interests.

Principal Investigator Responsibility: The Principal Investigator (PI) is responsible for the design, scientific and technical conduct, administrative oversight, fiscal accountability, regulatory oversight, and reporting for a research, instructional, or public services project, and, when required under sponsor regulation, that all project personnel not otherwise identified on this proposal form are current in such disclosures of known significant financial interests. If the sponsor allows, a project may have multiple Principal Investigators, or Co-Principal Investigators, who share the authority and responsibility for the project. If there are multiple Principal Investigators, then each person shall have the authority and be responsible for the proper conduct of the project and must certify.

Project Role Researcher Signature (Certification)

Proposal Approval(s) Minimum Approval: The Lead Unit’s Department Head, Unit Head, or an authorized delegate of either (Unit Head) approves (a) that the proposal aligns with the mission of unit (b) the qualifications of the researcher, (c) the availability of necessary unit space and resources, (d) the level of mentorship is appropriate (if applicable), (e) commitments of unit cost sharing, and (6) the unit’s commitment to support the proposal if funded. No person may sign this proposal form as both a Researcher and the Unit Head.

Conditional Approval(s): 1. An additional Department Head, Unit Head, or an authorized delegate of either (Unit Head) must sign to approve

commitments of unit cost sharing, or, otherwise, as required by process dictated within Unit, Sub-College, or College.2. The applicable College Dean or Institute Director (Unit Executive) must approve for any one or more of the following

situations: (a) commitments of college or institute cost sharing, (b) an exception to Eligibility to Serve as PrincipalInvestigator, (c) approval to proceed to request an exception request of Charging of Facilities and Administrative Costs toSponsored Projects, or (d) approval to proceed to request an exception request of an institutional policy on an internaldeadline for proposal submissions.

Org or College Code/Name Name Signature (Approval)

Page 3 of 3 Check box to add an Annex to collect additional certifications and/or approvals:

Proposal Intake Form Field Guidance

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Proposal Type 1. New: Request to initiate a new sponsored project. If applicable, then please provide a reference

number to a Pre-Proposal under “Account Info”.

2. Revision: Request to increase funding and SOW on an existing award (“Supplement”), which mayalso extend the POP (“Continuation/Amendment”). Please provide a reference number for theexisting award under “Account Info”.

3. Renewal: Request to initiate a new sponsored project, which is related to an existing award, and iffunded, would likely result in a new award number. Please provide a reference number for theprevious award under “Account Info”.

4. Resubmission: Request to replace a previously submitted proposal. Please provide a referencenumber for the replaced proposal under “Account Info”.

NOTE: For Just-In-Time requests, budget revision requests, any other request to submit additionalinformation related to a proposal that has submitted, but not yet award, then please submit a“Proposal Update”. A Proposal Intake Form (PIF) is not necessary.

Activity Type1. Research1

a. Research – Basic: Work undertaken primarily to acquire new knowledge without anyparticular application or use in mind. Source: NSF HERD Survey, FY14.

b. Research – Applied: Work conducted to gain the knowledge or understanding to meet aspecific, recognized need. Source: NSF HERD Survey, FY14.

c. Research – Development: The systematic use of the knowledge or understandinggained from research directed toward the production of useful materials, devices,systems, or methods, including the design and development of prototypes andprocesses. Source: NSF HERD Survey, FY14.

d. Fellowship: Scholarships and fellowships in the form of grants to students, resultingeither from selection by the institution or from an entitlement program. Source: NACUBOFunction Code 1700.

2. Instruction: Teaching and training activities of an institution. Except for research training as providedin subsection b, this term includes all teaching and training activities, whether they are offered forcredits toward a degree or certificate or on a non-credit basis, and whether they are offered throughregular academic departments or separate divisions, such as a summer school division or an

1 Sponsored Research means all research and development activities that are sponsored by Federal and non-Federal agencies and organizations. This term includes activities involving the training of individuals in research techniques (commonly called research training) where such activities utilize the same facilities as other research and development activities and where such activities are not included in the instruction function. 2 CFR §200 Appendix III.

Proposal Intake Form Field Guidance

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extension division. Also considered part of this major function are departmental research, and, where agreed to, university research. Source: 2 CFR §200 Appendix III.

3. Other Sponsored Activities

a. Other Sponsored Activity: Programs and projects financed by Federal and non-Federal

agencies and organizations which involve the performance of work other than instruction and organized research. Examples of such programs and projects are health service projects and community service programs. However, when any of these activities are undertaken by the institution without outside support, they may be classified as other institutional activities. Source: 2 CFR §200 Appendix III.

b. Public Service: Activities established to primarily provide non-instructional services beneficial to individuals and groups. Source: NACUBO Function Code 1200.

c. Clinical Trial: A project will be considered a clinical trial if it meets either of the following

definitions:

i. The project is registered on http://ClinicalTrials.gov, OR ii. The project is a controlled, clinical testing of Investigational New Drugs (INDs) or

Investigational Devices (IDEs) using either a sponsor or investigator developed protocol under an FDA Phase I, II, III, or IV drug study or an FDA-regulated medical device study, or the controlled clinical testing of a protocol performed under the sponsorship of an approved national cooperative consortium for clinical trial services. Projects involving animal subjects should not be classified as clinical trials.

Proposal Intake Form Field Guidance

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Indirect Cost Rate

Proposal Intake Form Field Guidance

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Project Characteristics Cost Exception (Administrative Costs) Restricted Costs are costs that federal regulations restrict charging directly to federal sponsored projects, though in some instances they are permitted as direct charges if there is explicit justification. These costs are allowable charges to indirect cost pools. Examples include administrative salaries, memberships, postage, office supplies, and telephone monthly line charges. The OBFS Section 16 Policy FAQs provide information on the type of information required in order to request that Restricted Costs be charged as Direct Costs on a project. Source: OBFS Section 16 Policy and FAQs. More information is available at 2 CFR §200.403 Factors Affecting Allowability of Costs and 2 CFR §200.413 Direct Costs.

Cost Sharing Policy: http://cam.illinois.edu/xi/xi-6.htm FAQs: http://go.illinois.edu/research_policies More information: 2 CFR §200.29 Cost Sharing or Matching.

F&A Waiver Request Policy: http://cam.illinois.edu/xi/xi-7.htm FAQs: http://go.illinois.edu/research_policies More information: 2 CFR §200.414 Indirect (F&A) Costs

Graduate College (Fellowship) The Graduate College must review and approve proposals that contain a pre-doctoral fellowship or pre-doctoral candidate component.

Limited Submission The OVCR oversees the limited submission selection process and chooses the proposals that will be submitted…The OVCR normally delegates responsibility for programs related to graduate student education and research to the Graduate College and may delegate responsibility for other specialized funding opportunities to other campus units. The delegated unit is responsible for the application process, reviews, and campus approval and may follow procedures different from those outlined. More information: https://research.illinois.edu/resources-research/limited-submissions.

PI Eligibility (Non-Tenure Track PI) Policy: http://cam.illinois.edu/xi/xi-4.htm FAQs: http://go.illinois.edu/research_policies More information: Communication 19: Sabbatical Leaves of Absence, Communication 25: Employment Guidelines for Specialized Faculty Holding Non-Tenure Systems Positions, and Communication 26: Promotion to Teaching, Research or Clinical Associate or Full Professor Titles.

Tuition Remission Waiver Request The Office of the Provost reviews requests to reduce or waive Tuition Remission when otherwise applicable.

Proposal Intake Form Field Guidance

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Special Review

Investigator-Specific COI Investigator-Specific COI is inclusive of both the following situations:

1. Conflict of Commitment: when the external activities of an academic staff member are so substantial or demanding of the staff member's time and attention as to interfere with the individual's responsibilities to the unit to which the individual is assigned, to students, or to the university; and

2. Conflict of Interest: a. when an academic staff member is in a position to influence either directly or indirectly

university business, research, or other decisions in ways that could lead to gain for the staff member, his/her immediate family, or any third party to the detriment of the university's integrity and its missions of teaching, research, economic development, and public service, OR

b. when an academic staff member desires to acquire a contract (outside of employment) to provide goods or services to the university.

Source: VPAA COCI Policy.

Sponsor-Specific COI As per the myDisclosures application, Sponsor-Specific COI encompasses NSF’s additional COI requirements as well as the PHS COI requirements. For the Proposal Intake Form (PIF), please mark “Pending” when the source of funds (sponsor or prime sponsor) is an agency that adopts the PHS COI requirements. For a comprehensive list, please refer to the Federal Demonstration Partnership (FDP) site for a list of agencies that adopt the PHS COI requirements.