TENNESSEE TECH UNIVERSITY PROPOSAL SUBRECIPIENT COMMITMENT
1. TO BE COMPLETED BY TENNESSEE TECH BEFORE SENDING TO SUBRECIPIENT:
Prime Sponsor:
TTU Principal
Investigator:
PI Email Address:
Office of Research
Contact:
2. TO BE COMPLETED BY PROPOSED SUBRECIPIENT:
Subrecipient Institution:
Principal Investigator (name and email):
Institutional Address with Zip + 4:
Congressional District
Organization:
DUNS #:
EIN #
CAGE Code (Sam.gov)
Project Title:
Required proposal documents attached: Scope of work Budget & budget justification
Other documents as required by agency
NOTE: Period of performance & budget information may be revised upon receipt of award.
PERIOD OF PERFORMANCE
TOTAL SUBRECIPIENT COSTS
Direct Costs
$
$
F&A
$
Do you have a Negotiated Indirect Cost Rate Agreement with a U.S. cognizant agency (e.g., ONR, DHHS, etc.)?
(Note: Sponsor or funding opportunity restrictions on indirect costs take precedence.)
YES: Provide the URL or a copy with form:
NO: Unless other restrictions or sponsor conditions exist, the Uniform Guidance (2 CFR 200.331 (a)(4)) de minimus
10% MTDC indirect cost rates will apply.
Cost Sharing
YES
Amount:
$
(If applicable, cost sharing amounts and justification must be included in the Subrecipient’s budget.)
3. REQUIRED SUBRECIPIENT CERTIFICATIONS
AUDIT: Is Subrecipient subject to Uniform Guidance 2 CFR 200.331 Subpart F Audit Requirements?
YES: Most recent fiscal year audit completed:
NO: TTU requires Subrecipient to complete a financial status questionnaire as well as a limited scope audit before a
subaward will be issued.
PHS/NIH, NSF: Has Institution implemented a written policy for Investigator Financial
Disclosure and Conflict of Interest consistent with agency requirements?
Yes
No
N/A
NSF, USDA-NIFA: Institution certifies that a Responsible Conduct of Research (RCR)
Training Plan is in place consistent with agency requirements.
Yes
No
N/A
Subrecipient or Subrecipient Principal Investigator Debarred or Suspended
Yes
No
Human Subjects
Yes
No
If Yes: FWA #
Human Stem Cells
Yes
No
Animal Subjects
Yes
No
If Yes: Assurance #
Animals
Euthanized?
Yes
No
The appropriate program and administrative personnel of the institution involved in this applicatoin are aware of the
sponsoring agency’s guidelines and are prepared to enter into good faith negotiations to establish the necessary inter-
institutional agreement(s). The institution makes all applicable assurances/certifications.
Authorized Administrative or Representative Signature Date
(a person authorized to submit proposals on behalf of your organization)
Printed Name and Title: _______________________________________ Phone: __________________________________
click to sign
signature
click to edit