Principal Investigator:
Sponsor:
SECTION B. REQUIRED SUBCONTRACT ATTACHMENTS
Distinct statement of work (SOW) for subcontractor for New subcontract or a Mod if SOW has been revised
Subcontractor's work involves human subjects. If Yes, attach their current IRB approval
Subcontractor's work involves animals. If Yes, attach their current IACUC approval. If at a foreign site, follow UVA ACUC guidance
(434-924-0405) & attach the Certification of Review of Animal Research Subcontracted to Foreign Institutions issued by the ACUC.
SECTION C. SET UP SUBCONTRACT PROJECT BUDGET IN INTEGRATED SYSTEM AS FOLLOWS:
SECTION D. CERTIFICATION AND SIGNATURE
Do you, your spouse, or any other persons living with you have any financial interests (more than 3% equity or more than $10,000 annual income) in the
subcontracting organization, or which might reasonably appear to be affected by the proposed research.?
http://www.virginia.edu/vprgs/polproc.html and http://www.virginia.edu/vprgs/rsrchcompliance.html If Yes, refer also to
the UVA financial Administration Procedure Manual for additional details on filing the necessary disclosure and the Virginia Statement of
Economic
Interests. See: http:/www.virginia.edu/finance/polproc/proc/15-1.html
Yes
No
This request and its attachments have been reviewed and approved by the undersigned:
Principal Investigator: ____________________________________________________
Total Subcontractor Budget(direct + indirect) =
UVA F & A (if allowed on first $25,000) =
Total funds to transfer to subcontract project =
Date: ________________________________________
Department Administrator : _____________________Date:___________ School Administrator: ___________________________Date: _______________
Contact person for OSP questions:
FOR OSP USE ONLY
End date of Master
Funds Available $
Yes No
Yes No
(This total must be the same as the attached budget)
Transfer funds FROM
IS Award-Project No.:
Contact's Email Address
Detail budget (direct + indirect) for subcontractor and a budget justification. Budget must include cost share if applicable.
Parent Award/Project #
Was the subcontract in the original proposal? If No, Attach explanation and sponsor approval if required.
Yes
No
SECTION A. WHAT TYPE OF REQUEST IS THIS? (Make choice)
ORG # (OPTIONAL)
UNIVERSITY OF VIRGINIA
SUBCONTRACT/SUBAWARD REQUEST FORM
Request to issue Subcontract/Subaward or Modification to outside entity
Form SP-30 OSP (revised 04.7.11)
This form must be completed in its entirety
Budget Period Start Date:
End Date:
Subcontractor Legal Name:
Subcontractor PI:
Total Amount $
Address:
Phone No.:
Fax No:
Email:
Subcontractor Address:
Subcontractor Phone No.:
Email:
Subcontractor Sponsored
Programs Contact:
NEW REQUEST FOR SUBCONTRACT/SUBAWARD
Fax No:
dd mmm yyyy
dd mmm yyyy
dd mmm yyyy
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