Full Grant Application

This application is a continuation of the pre-inquiry application. If your pre-inquiry application was not approved, do not submit this application.

Please attach applicable sections of the research plan, below.

Introduction to Application (for RESUBMISSION or REVISION only)

Accepted file types: pdf, Max. file size: 10 MB.

Specific Aims

Accepted file types: pdf, Max. file size: 10 MB.

Research Strategy*

Accepted file types: pdf, Max. file size: 10 MB.

Progress Report Publication List

Accepted file types: pdf, Max. file size: 10 MB.

Human Subjects Sections

Protection of Human Subjects

Accepted file types: pdf, Max. file size: 10 MB.

Inclusion of Women and Minorities

Accepted file types: pdf, Max. file size: 10 MB.

Inclusion of Children

Accepted file types: pdf, Max. file size: 10 MB.

Other Research Plan Sections

Vertebrate Animals

Accepted file types: pdf, Max. file size: 10 MB.

Select Agent Research

Accepted file types: pdf, Max. file size: 10 MB.

Multiple PD/PI Leadership Plan

Accepted file types: pdf, Max. file size: 10 MB.

Consortium/Contractual Arrangements

Accepted file types: pdf, Max. file size: 10 MB.

Letters of Support

Accepted file types: pdf, Max. file size: 10 MB.

Resource Sharing Plan(s)

Accepted file types: pdf, Max. file size: 10 MB.

Appendix (if applicable)

Appendix

Accepted file types: pdf, Max. file size: 10 MB.

PHS 398 Cover Page Supplement

Project Director / Principal Investigator (PD/PI)

Name*

Prefix First Middle Last Suffix

Human Subjects

Clinical Trial?

No
Yes

Agency-Defined Phase III Clinical Trial?

No
Yes

Disclosure Permission Statement

If this application does not result in an award, is the Government permitted to disclose the title of your proposed project, and the name, address, telephone number and e-mail address of the official signing for the applicant organization, to organizations that may be interested in contacting you for further information (e.g., possible collaborations, investment)?*

No
Yes

Program Income

Is program income anticipated during the periods for which the grant support is requested?*

No
Yes

Table Placeholder*

Human Embryonic Stem Cells

Does the proposed project involve human embryonic stem cells?*

No
Yes

If the proposed project involves human embryonic stem cells, list below the registration number of the specific cell line(s) from the following list: http://stemcells.nih.gov/research/registry/. Or, if a specific stem cell line cannot be referenced at this time, please click the box indicating that one from the registry will be used:*

Cell Line(s):

Specific stem cell line cannot be referenced at this time. One from the registry will be used.
Second Choice
Third Choice

Inventions and Patents (For renewal applications only)

Inventions and Patents:*

No
Yes

Previously Reported:*

No
Yes

Change of Investigator / Change of Institution Questions

Name*

Change of principal investigator / program director

Prefix First Middle Last Suffix

Name of former Institution:*

Change of Grantee Institution

RESEARCH & RELATED Senior/Key Person Profile (Expanded)

Profile – Project Director/Principal Investigator

Name*

Project Director/Principal Investigator

Prefix First Middle Last Suffix

Organization Name*

Division*

Department*

Position/Title*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Project Director/Principal Investigator Phone*

Project Director/Principal Investigator Email*

Credential, e.g., agency login:

Project Role:*

Other Project Role Category:

Degree Type:

Degree Year:

Attach Biographical Sketch:

Accepted file types: pdf, Max. file size: 8 MB.

Attach Current & Pending Support:

Accepted file types: pdf, Max. file size: 8 MB.

RESEARCH & RELATED Other Project Information

Are Human Subjects Involved?

Yes
No

Is the Project Exempt from Federal regulations?

Yes
No

If yes, check appropriate exemption number.

If no, is the IRB review Pending?

Yes
No

IRB Approval Date:

Human Subject Assurance Number:

Are Vertebrate Animals Used?

Yes
No

Is the IACUC review Pending?

Yes
No

IACUC Approval Date

Animal Welfare Assurance Number:

Is proprietary/privileged information included in the application?

Yes
No

Does this Project Have an Actual or Potential Impact – positive or negative – on the environment?

Yes
No

If yes, please explain:

If this project has an actual or potential impact on the environment, has an exemption been authorized or an environmental assessment (EA) or environmental impact statement (EIS) been performed?

Yes
No

If yes, please explain:

Is the research performance site designated, or eligible to be designated, as a historic place?

Yes
No

If yes, please explain:

Does this project involve activities outside of the United States or partnerships with international collaborators?

Yes
No

If yes, identify countries:

Optional Explanation:

Project Summary/Abstract: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

Project Narrative: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

Bibliography & References Cited: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

Facilities & Other Resources: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

Equipment: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

Other Attachments: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

RESEARCH & RELATED BUDGET- Budget Period 1

Organizational Duns:

Enter name of Organization:

Budget Type:

Project
Subaward/Consortium

Budget Period:

1

Start Date*

End Date*

Senior/Key Person

Prefix First Middle Last Suffix

Base Salary ($)

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Fringe Benefits ($):

Funds Requested ($):

Project Role:

PD/PI
Co-PI/PD
Postdoctoral Associates
Other Professionals

Add Additional Key Person

Yes
No

Additional Senior Key Persons: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

Total Funds requested for all Senior Key Persons in the attached file:

Total Senior/Key Person:

Other Personnel

Post Doctoral Associates

Number of Personnel:

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Fringe Benefits ($):

Funds Requested ($):

Graduate Students

Number of Personnel:

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($)

Fringe Benefits ($)

Funds Requested ($)

Undergraduate Students

Number of Personnel:

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($)

Fringe Benefits ($)

Funds Requested ($)

Secretarial/Clerical

Number of Personnel:

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Fringe Benefits ($):

Funds Requested ($):

Other

Add Additional Other Personnel?

Yes
No

Total Number Other Personnel:

Total Other Personnel:

Total Salary, Wages and Fringe Benefits (A+B):

Equipment Description

List items and dollar amount for each item exceeding $5,000

Equipment item:

Funds Requested:

Add Additional Equipment?

Yes
No

Additional Equipment: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

Total funds requested for all equipment listed in the attached file:

Total Equipment:

Travel

Domestic Travel Costs ( Incl. Canada, Mexico and U.S. Possessions)

Funds Requested ($):

Foreign Travel Costs

Funds Requested ($):

Participant/Trainee Support

Tuition/Fees/Health Insurance

Funds Requested ($):

Stipends

Funds Requested ($):

Travel

Funds Requested ($):

Subsistence

Funds Requested ($):

Other

Funds Requested ($):

Number of Participants/Trainees:

Total Participant/Trainee Support Costs:

Other Direct Costs

Materials and Supplies

Funds Requested ($):

Publication Costs

Funds Requested ($):

Consultant Services

Funds Requested ($):

ADP/Computer Services

Funds Requested ($):

Subawards/Consortium/Contractual Costs

Funds Requested ($):

Equipment or Facility Rental/User Fees

Funds Requested ($):

Alterations and Renovations

Funds Requested ($):

Total Other Direct Costs:

Direct Costs

Total Direct Costs (A thru F)

Funds Requested ($):

Indirect Costs

Indirect Cost Type:

Indirect Cost Rate (%):

Indirect Cost Base ($):

Funds Requested ($):

Add Additional Indirect Cost?

Yes
No

Total Indirect Costs:

Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number):

Total Direct and Indirect Costs

Total Direct and Indirect Institutional Costs (G + H)

Funds Requested ($):

Fee

Funds Requested ($):

Budget Justification

(PDF Submission)

Only attach a single file.

Accepted file types: pdf, Max. file size: 10 MB.

RESEARCH & RELATED BUDGET- Budget Period 2

Organizational Duns:

Enter name of Organization:

Budget Type:

Project
Subaward/Consortium

Budget Period:

1

Start Date

End Date

Senior/Key Person

Senior/Key Person Name

Prefix First Middle Last Suffix

Base Salary ($):

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Fringe Benefits ($):

Funds Requested ($):

Project Role:

PD/PI
Co-PI/PD
Postdoctoral Associates
Other Professionals

Add Additional Key Person

Yes
No

Additional Senior Key Persons: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

Total Funds requested for all Senior Key Persons in the attached file:

Total Senior/Key Person:

Other Personnel

Post Doctoral Associates

Number of Personnel:

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Sum. Fringe Benefits ($):

Funds Requested ($):

Graduate Students

Number of Personnel: (TEF)

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Fringe Benefits ($):

Funds Requested ($):

Undergraduate Students

Number of Personnel:

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Fringe Benefits ($):

Funds Requested ($):

Secretarial/Clerical

Number of Personnel:

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Fringe Benefits ($):

Funds Requested ($):

Other

Number of Personnel:

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Fringe Benefits ($):

Funds Requested ($):

Add Additional Other Personnel?

Yes
No

Total Number Other Personnel:

Total Other Personnel:

Total Salary, Wages and Fringe Benefits (A+B):

Equipment Description

List items and dollar amount for each item exceeding $5,000

Equipment item:

Funds Requested:

Add Additional Equipment?

Yes
No

Additional Equipment: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

Total funds requested for all equipment listed in the attached file:

Total Equipment:

Travel

Domestic Travel Costs ( Incl. Canada, Mexico and U.S. Possessions)

Funds Requested ($):

Foreign Travel Costs

Funds Requested ($):

Participant/Trainee Support

Tuition/Fees/Health Insurance

Funds Requested ($):

Stipends

Funds Requested ($):

Travel

Funds Requested ($):

Subsistence

Funds Requested ($):

Other:

Funds Requested ($):

Number of Participants/Trainees:

Total Participant/Trainee Support Costs:

Other Direct Costs

Materials and Supplies

Funds Requested ($):

Publication Costs

Funds Requested ($):

Consultant Services

Funds Requested ($):

ADP/Computer Services

Funds Requested ($):

Subawards/Consortium/Contractual Costs

Funds Requested ($):

Equipment or Facility Rental/User Fees

Funds Requested ($):

Alterations and Renovations

Funds Requested ($):

Total Other Direct Costs:

Direct Costs

Total Direct Costs (A thru F)

Funds Requested ($):

Indirect Costs

Indirect Cost Type:

Indirect Cost Rate (%):

Indirect Cost Base ($):

Funds Requested ($):

Add Additional Indirect Cost?

Yes
No

Total Indirect Costs:

Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number):

Total Direct and Indirect Costs

Total Direct and Indirect Institutional Costs (G + H)

Funds Requested ($):

Fee

Funds Requested ($):

Budget Justification

(PDF Submission)

(Only attach one file.)

Max. file size: 300 MB.

RESEARCH & RELATED BUDGET – Budget Period 3

Organizational Duns:

Enter name of Organization:

Budget Type:

Project
Subaward/Consortium

Budget Period:

1

Start Date:

End Date:

Senior/Key Person

Senior/Key Person Name

Prefix First Middle Last Suffix

Base Salary ($):

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($)

Fringe Benefits ($):

Funds Requested ($):

Project Role:

First PD/PI
Co-PI/PD
Postdoctoral Associates
Other Professionals

Add Additional Key Person?

Yes
No

Additional Senior Key Persons: (PDF Submission)

Accepted file types: pdf, Max. file size: 10 MB.

Total Funds requested for all Senior Key Persons in the attached file:

Total Senior/Key Person: (TEF)

Other Personnel

Post Doctoral Associates

Number of Personnel:

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Fringe Benefits ($):

Funds Requested ($):

Graduate Students

Number of Personnel:

Months

Cal.:

Acad.:

Sum.:

Requested Salary ($):

Fringe Benefits ($):

Funds Requested ($):

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