Fillable PRF V6 - Proposal_Routing_Form

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PRF V6 - Proposal_Routing_Form

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Dateduetosponsor(andtime)

DatecompleteproposalduetoORSP

(Completeproposalmaterialsmustbedeliveredto

ORSP5businessdaysbeforesponsorduedate.)

Research&SponsoredProjectsProposalRoutingForm(PRF)

ProposalswillnotbesubmitteduntilrequiredProposalRoutingdocumentsarecompletedandcontainallrequiredsignatures.Itisthe

responsibilityofthePItoensurealldocumentsaresignedandsubmittedtotheORSP5daysbeforethesponsordeadline. Project narrative

and final budget must accompany this form when submitted to Chair and Dean for review and approval.

ProposalInformation

1‐PrincipalInvestigator(ProjectManager,LeadInvestigator)

2‐emailaddress

3‐Department/CollegeorDivision

4‐Sponsor/Agency Federal State Foundation Business Other

$

5‐ProjectTitle 6‐TotalAmountRequestedfromSponsor

7‐ProjectBegindate:

8‐ProjectEnddate:

9‐Classification: New Supplementto

Revisionof Continuation/Renewalof

10‐TypeofProject

Research

Equipment

Service/Consulting

AcademicSupport

StudentServices

Other

11‐ProgramorSolicitationNumber(orInsertlinktotherequestforproposal)

Yes No

11a‐IhavereadandunderstandtheRFPandsponsorrequirements

11b‐Isthisproposalsubjecttoalimitedsubmission?

Yes No

12‐Wherewilltheworkbepe

rformed?(on/offcampus,building/lab)

13‐Iscostsharingbeingproposedaspartofthisproject? Yes* No

*IfCostSharingisinvolved:Form“UWGORSPCo stShare Request”mustbecompletedandsubmittedwiththisform.

14‐DoesthesponsorrequirethattheprojectbesustainableoristherearequirementofanyongoingUWGcommitmenttothe

projectbeyondthefundingperiod? Yes No

15‐HaveyouincludedUWG’sfederallynegotiatedIndirectCostrate? Yes No

IfNo,Areyouusingthesponsormandatedrate? Yes No

IfyouarenotusingtheUWGnegotiatedrateorasponsormandatedrate,pleaseattachtheUWGF&AWaiverForm.

16‐Isa GraduatestudenttuitionwaiverrequestedfromtheSponsor?

Yes* No

*Ifstudenttuitionistobewaived,butisnotrequestedfromtheSponsor(Universitypaid),thiswaiverrepresentsacostshare.Thiscostshare,

valueoftuition,mustberecordedontheORSPCostShareRequestForm.

OfficeofResearch&

SponsoredProjects

PRF November 2016 (v.6)

Project is Subaward

Project includes Subaward

PersonnelInformation

17‐ThePIshouldcompletethissectionwithhis/herowninformation.Allkeypersonnelandanypersonnelwhowillbepaidfrom

sponsorfunds(oruniversityfundstoworkonthisproject‐CostShare)shouldbelistedunderthe“AdditionalPersonnel”section

ofthisForm.PleasehaveallCo‐PIs/key personelcompletetheCo‐PI/ProjectPersonnelForm.

YEAR1 YEAR2

Sponsorpaid

%effort

Sponsorpaid

projectsalary

UWGpaid

%effort

UWGpaid

projectsalary

Sponsorpaid

%effort

Sponsorpaid

projectsalary

UWGpaid

%effort

UWGpaid

projectsalary

Fall

Spring

Summer*

Total

YEAR3 YEAR4

Sponsorpaid

%effort

Sponsorpaid

projectsalary

UWGpaid

%effort

UWGpaid

projectsalary

Sponsorpaid

%effort

Sponsorpaid

projectsalary

UWGpaid

%effort

UWGpaid

projectsalary

Fall

Spring

Summer*

Total

YEAR5

AccounttopayUWGportionofsalary:

18‐

TheauthorizedapproverfortheUWGDepartmentAccountpaying

projectsalarymustsign

below.

Signature:

ProjectsalarynotpaidbythesponsorconstitutesaCostShareandmust

alsoberecordedontheUWGCostShareRequestandattachedtothisPRF.

Sponsorpaid

%effort

Sponsorpaid

projectsalary

UWGpaid

%effort

UWGpaid

projectsalary

Fall

Spring

Summer*

Total

ComplianceInformation

19‐PleasecompletetheComplianceInformation:

Yes No

Yes No *IRB#

IhavereadandunderstandtheUWGFinancialConflictofInterest

 Policy

IhavecompletedFCOItrainingandsubmittedaSignificantFinancial

 InterestForm

IhaveaFinancialConflictofInterest

DoesthisprojectinvolvetheuseofHumanSubjects?

DoesthisprojectinvolvetheuseofVertebrateAnimals?

Yes No *IACUC#

Yes No

Yes No

DoesthisprojectinvolveHazardousWaste?

(ifyes,musthaveRiskManagementapprovalonsignaturepage)

Doesthis

projectinvolverecombinantDNAorradioactivesubstances?

Doesthisprojectinvolvecapitalimprovementsorspacerenovation?

Willthisprojectinvolvetheexportofinformationormaterialto

 anothercountry(ITAR/EAR)?

Areuniversityhousingorcontinuingeducationservicesinvolved?

Isanexternalevaluatorrequired?

 Ifso,hastheexternalevaluatorbeenincludedinthebudget?

Haveaccuratecostinformationforitems<$1,000?

Haveaccuratequotesforitems>$10,000?

Yes No

Theseitemsmustbeverified

bytheUniversityResearch

ComplianceOfficerbefore

thegrant/proposalcanbe

submitted.

PRF November 2016 (v.6)

N/A

ORSPUseOnly

Federal Debarment & Suspension check:

Subaward Commitment Form, sub-budget, SOW,

AlldocumentsreceivedinORSP:

Anticipatedawardnotification:

BasisforSalaryverified,

source & date:

sub-biosketches included:

Compliance Review & Approval:

AdditionalPersonnelInformation

20‐Pleaselistalladditionalpersonnelwithoutwhomthisprojectcouldnotreasonablybecompleted.(Pleaseattachadditional

sheetsifnecessary).EachCo‐PI or UWG faculty/staff paid on this projectshouldcompletea“Co‐PI/

ProjectPersonnelForm”andit shouldbeattachedtoandsubmittedwiththisPRFforsubmissiontoORSP.

Name Role/Title

Sourceoffunding:

“Sponsor”or“CostShare”

#ofpersonsin

thisrole

Pleaselist“graduatestudent”or“undergraduate”ifexactpersonhasnotbeenidentified.(Ifmultiplestudents,pleaselisttheapproximate

numberofstudentsinvolved.)

Signatures

‐Bysigningandsubmittingthisproposal,Icertifythat:(1)theinformationsubmittedwithintheapplicationistrue,complete,andaccuratetothe

bestofmyknowledge;(2)anyfalse,fictitiousorfraudulentstatementsorclaimsmaysubjectmetocriminal,civil,oradministrativepenalties;(3)I

agreetoacceptresponsibilityforthescientificconductoftheprojectandprovidetherequiredprogressreports;and(4)Iagreetoacceptthe

obligationtocomplywithawardtermsandconditionsandUniversity’spoliciesandproceduresifanawardismadeasaresultofthisapplication.



Department Chair/Supervisor and Dean/Designee should not sign form unless it is accompanied by

a project narrative and budget.

PISignature Name(printed) Date

Dept.Chair/Supervisor(ifnotAcademicAffairs) Name(printed) Date

Dean/Designee Name(printed) Date

HRM–Acknowledgementofinclusionofhazardouswaste Date

AssociateVicePresidentforResearch&SponsoredProjects Date

PRF November 2016 (v.6)

ProposalRoutingFormInstructions

PartI:ProposalInformation

1‐3.ThePIistheprimarypointofcontactformatterspertainingtoyourproposal–fillinyourname,e‐mail,

Department/College(orDivision).IfyouarecollaboratingwithoneormoreCo‐PIs,theyeachmustfillouttheCo‐

PI/ProjectPersonnelformontheORSPPre‐AwardProposalRoutingFormspage.

4. Sponsor/Agency‐inadditiontotheagencyname;pleaseindicatewhethertheyareaFederalagency,Stateagency,

Foundation,Business,orOtheragencythatdoesnotfitthepreviouscategories.

5. Proposaltitle/TitleoftheProject

6. Thetotalamount(Direct+F&A)youarerequestin

gfromtheSponsor

7–8.Thedateyouwouldliketostartyourprojectandthedatebywhichyouplantohaveprojectcompleted.

9. Classification:indicatewhetherthisprojectis:

New:thisisthefirsttimethisproposalwillbesubmittedtothefundingagencylistedinstep4.

Pre‐Proposal(LetterofIntent):aletterordocumentthatdescribesthePrincipalInvestigatorsintentionsubmita

grantproposaltothefundingagency.

Revisionof:Revisionofproposalpreviouslysubmittedtosponsororchangesinbudgetorscopeofworkasrequired

bysponsor.

Supplementto:anotificationthatadditionalmoneyhasbeenawardedtoanexistinggrant.Pleaseincludethegrant

number.

Continuation/Renewalof:Competingrenewalorcompetingcontinuationofapreviouslyawardedproject.

10. Projecttype–isthisresearch,equipment,service/consulting,academicsupport,studentservices,orsomeother

typenotlisted(pleasedescribeinspaceprovided)?

11. Providetheprogramname,solicitationnumber,andalinktotheRequestForProposal(RFP).Alsoindicatewhether

youhavefullyreviewedandunderstandtheRFP,andwhetherornotitisalimitedsubmission(e.g.onlytwoproposals

peruniversitymaybesubmittedduringafundingcycle).

12. Indicatewherethemajorityofworkproposedintheprojectwillbeperformed.

13. IndicateifCostShareisproposedorrequiredaspartofthisproject.Allproposedcostsharingmustbeincludedon

theCostShareformandsubmittedwiththisPRF.

14. Somesponsorsrequirethattheprojecttobefundedcontinuebeyondthesponsorfunding.Thismayincludea

requirementofpersonneltimeorprograms/projectsbeconductedonacontinuingbasisaftersponsorfundinghas

stopped.PleasereviewtheRFPcarefullyforanycommitmentsrequiredoverandabovewhatthesponsorwillpay

duringtheprojectdates.

15. IndicatewhetherornotFacilitiesandAdministrativeCosts(F&A),formerlycalledIndirectCosts,havebeen

requested(37.5%oncampus,13%offcampus).Pleaseindicateifthesponsormandatesalowerrateor does not allow

F&A, andyouhaveused thelowerrate (or 0%)inyourbudgetcalculations.AttachacopyoftheSponsor’spublished

policyonF&A(indirectcost)rates.

Tobeeligibletousetheoffcampusrate:morethan51%oftheprojectisperformedoff‐campus,asindicatedbythe

majorityoftheUWGexpendituresandthemajorityoftimefortheprojectwillbespentoff‐campuseachbudgetyear.In

suchcasestheoff‐campusratewillapplytotheentireprojectasgrantsorcontractsmaynotbesubjecttomorethan

oneF&Acostrate.

PRF November 2016 (v.6)

IfF&AhasnotbeenrequestedorisrequestedatratelowerthanUWGsFederallyNegotiatedRateorthepublished

sponsorapprovedrate,aF&A Cost Waiverformisrequired.

16. IndicateifgraduatetuitionhasbeenrequestedfromtheSponsor.IfUWGwillbepaying/waivinggraduatestudent

tuition,thisconstitutesacostshareandmustbeincludedontheCost Share form.

PartII:PersonnelInformation

Inordertobecompliantwithfederalguidelines,ORSPmustcollectandevaluatethefollowingeffortinformation.

17. Pleaseusetheprovidedtabletoindicatethepercentofeffortandsalarytiedtothisproject,andwhetherthat

percentageispaidbySponsorfundingorUWGfunding. *This is the % of your total semester effort & salary paid by the

sponsor or University for this project only. DO NOT include fringe in your calculations for effort.

• Thefirsttwocolumnsineachsemesteraretoindicatethepercentageofeffortandsalarypaidbythesponsor.

• Thethirdandfourthcolumnsofeachsemesteraretoindicatethepercentageofeffortandsalarydevotedtothe

projectbutpaidbytheUniversity(such effort constitutes aCostShare unless part of your institutional research).

Tomeetthereportingand auditingrequirementsofthesponsoringagencies,cost‐sharingcommitmentsmustbe

chargedtoaseparatecost‐sharingacco untrelatedtothespecifiedproject.

*SummereffortmaybelistedinthePersonMonth(percentagethereof)equivalentiffuturesummerworkload/teaching

isunknown.SummerlistedinPersonMonthequi valentshouldbelistedas“1SM”for1summermonth(2SM,etc.).

The“Effort‐PersonMonth‐Converter”formmaybeusedtocalculateeffort/personmonthequivalents.

18. IfthereisprojecteffortandsalarycomingfromtheUniversity,theaccountfromwhichthesefundswillcomemust

belisted,alongwiththesignatureoftheauthorizedapproverforthatuniversityaccount. If institutional research please

type "institutional research" in this box.

PartIII:ComplianceInformation

19. Pleaseanswerallquestions.

FinancialConflictofInterest(FCOI):ToensurethatUWGcomplieswithallapplicablefederalandstatelaws;weare

requiredtonoteandtrackthefollowingpiecesofinformation.ASignificantFinancialInterest(SFI)Formmustbe

completedforeachproposalbeingsubmitted,andforfundedprojects,aSFIformmustberenewedannually.

Allprojectpersonnelwhoareinvolvedinthedesign,conduct,orreportingmustcompletethe CITI Financial Conflict of

InteresttrainingandaSignificantFinancialInterest(SFI)Form.

Intheeventofafinancialconflictofinterest,aFCOIDisclosureformmustbecompletedandsubmittedtotheORSP.

InformationregardingtheUniversityFCOIpolicymaybefoundhere:http://www.westga.edu/assetsDept/orsp/UWG‐

FCOI‐Policy.pdf.

PartIV:AdditionalPersonnel

20. ThougheachCo‐PI or UWG faculty/staff working on the project shouldcompletetheCo‐PI/Key Personnel

form,pleaselisteachpersonwithoutwhomthisprojectcouldnotbe completed(includingCo‐PIs,staff,graduateand

undergraduatestudents),attachingadditionalsheetsasneeded.

PartV:Signatures

21. Pleasemakesureallnecessarysignaturesareincluded.Proposalswillnotbesubmittedtosponsorswithoutall

ProposalRoutingdocumentsbeingfullysignedandreceivedintheORSP.

PRF November 2016 (v.6)

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