Fillable Uwg Subrecipient Commitment Form Subrecipient Commitment Form

Fill Online, Printable, Fillable, Blank Uwg Subrecipient Commitment Form Subrecipient Commitment Form Form

Use Fill to complete blank online WEST GEORGIA COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Uwg Subrecipient Commitment Form Subrecipient Commitment Form

On average this form takes 14 minutes to complete

The Uwg Subrecipient Commitment Form Subrecipient Commitment Form form is 3 pages long and contains:

  • 0 signatures
  • 50 check-boxes
  • 31 other fields

Country of origin: US
File type: PDF

U.S.A. forms for West Georgia College

BROWSE WEST GEORGIA COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
SUBRECIPIENT COMMITMENT FORM
!
Subrecipient Legal Name:
Subrecipient PI Name:
Address: City: State:
Proposal Title:
Performance Period Begin Date: End Date
UMB PI’s Name:
Funding Agency
SECTION A – Proposal Documents
The following documents are included in our proposal submission and covered by the certifications below (check as applicable):
STATEMENT OF WORK (required)
BUDGET AND BUDGET JUSTIFICATION (required)
Biosketches of all Key Personnel, in agency-required format
Other:
Other:
SECTION B – Certifications
1. Facilities and Administrative Rates included in this proposal have been calculated based on:
(please attach a copy of your F&A rate agreement or provide a URL link to the agreement)
Our F&A rate for this type of work is limited to a published statutory F&A cap by a federal program
Our federally-negotiated F&A rate for this type of work.
A rate lower than our federally negotiated F&A rate, as listed in our proposal.
Our F&A rate for this type of work has been previously negotiated with UMB that we hereby agree to accept.
10% MTDC de minimus rate (Subrecipient has never had a federally negotiated rate)
2. Fringe Benefit Rates included in this proposal have been calculated based on:
Rates consistent with or lower than our federally-negotiated rates
(If this box is checked, please attach a copy of your FB rate agreement or provide a URL link to the agreement)
Other rates (please specify the basis on which the rate has been calculated in Section D Comments below).
3. Small Business Concern Yes No
Subrecipient represents that it is a small business concern as defined in 13 CFR 124.1002
If “Yes”: Subrecipient represents that it is a:
Small disadvantaged business as certified by the Small Business Administration
Women-owned small business concern
Veteran-owned small business concern
Service-disabled veteran-owned small business concern
HUBZone small business concern
4. Cost Sharing or Matching Yes No Amount:
Cost sharing or Matching amounts and justification should be included in the Subrecipient’s budget
5. Human Subjects Yes No Approval Date: Pending Approval
If “Yes”: Copies of the IRB approval must be provided to UMB. It is understood that no funds may be expended for human
subject related activities until all appropriate human subject approvals are in place.
If “Yes””: Have all key personnel involved completed Human Subjects Training? Yes No
6. Animal Subjects Yes No Approval Date: Pending Approval
If “Yes”: Copies of the IACUC approval must be provided to UWG. It is understood that no funds may be expended for
a
nimal related activities until all appropriate animal related approvals are in place.
O
f
f
i!
ORSP July 2016 (v.3)
SUBRECIPIENT COMMITMENT FORM
!
7. Conflict of Interest (applicable to PHS & NSF funded projects or agencies that have adopted the federal financial disclosure
requirements)
Please check the appropriate responses below
a. Not applicable because this project is not being funded by PHS (NIH, CDC, AHRQ, etc.), NSF, or any other sponsor
that has adopeted the federal financial disclosure requirements. See
http://sites.nationalacademies.org/PGA/fdp/PGA_070596 for list of sponsors that adopted federal financial disclosure
requirements
For PHS Funded Projects ONLY:
b.1
Subrecipient Organization/Institution is listed on the FDP Clearinghouse (http://sites.nationalacademies.org/PGA/fdp/PGA_070596)
and certifies that it has an active and enforced conflict of interest policy that is consistent with the provision of 42 CFR Part 50,
Subpart F “Responsibility of Applicants for Promoting Objectivity in Research” and 45 CFR Part 94 “Responsible Prospective
Contractors.” Subrecipient also certifies that, to the best of Institution’s knowledge, (1) all financial disclosures will be made related
to the activities that may be funded by or though a resulting agreement, and required by its conflict of interest policy, and (2) all
identified conflicts of interest have or will have been satisfactorily managed, reduced or eliminated in accordance with subrecipient’s
conflict of interest policy prior to the expenditures of any funds under any resultant agreement and within a timely manner sufficient
to enable timely FCOI reporting.
b.2
Subrecipient will follow the Conflict of Interest Policy established and eforced by his/her institution. Subrecipient certifies that the
Conflict of Interest Policy established is consistent with the provision of 42CFR Part 50, Subpart F “Responsibility of Applicants for
Promoting Objectivity in Research” and 45 CFR Part 94 “Responsible Prospective Contractors.”
b.3
Subrecipient does not have an active and/or enforced conflict of interest policy and agrees to adopt the University of Maryland,
Baltimore’s policy located at http://cf.umaryland.edu/umpolicies/printPolicy.cfm?polid=382
c. By signing below, Subrecipient certifies that the required training will be completed by each investigator prior to engaging in any
resear
ch related to any PHS funded contract/grant. For those adopting University of Maryland, Baltimore’s policy, the training is
located online at http://www.umaryland.edu/oac/research/research-integrity-and-compliance/conflict-of-interest/
8. Debarment and Suspension
Is the PI or any other employee or student participating in this project debarred, suspended or otherwise excluded from or
ineligible for participation in federal assistance programs or activities? Yes No
(
if “Yes”, explain in Section D Comments below)
The Subrecipient certifies they: (answer all questions below)
Are Are not Presently debarred, suspended, proposed for debarment, or declared ineligible for
award of federal contracts.
Are Are not Presently indicted for, or otherwise criminally or civilly charged by a governmental
entity
Are Are not Within three (3) years preceding this offer, been convicted of or had a civil judgment
rendered against them for commission of fraud or criminal offense in connection
with obtaining, attempting to obtain, or performing a public (federal, state or local)
contract or subcontract; violation of Federal or State antitrust statutes relating to the
submission of offers; or commission of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making false statement or receiving stolen
property.
Are Are not Within three (3) years preceding this offer, had one or more contracts terminated for
default by any federal agency
SECTION C – Audit Status
9. Audit Status
Subrecipient receives an annual audt in accordance with Uniform Guidance 2 CFR 200
Most recent fiscal year completed: FY
Subrecipient DOES NOT receive an annual audit in accordance with Uniform Guidance 2 CFR 200.
Subrecipient is a: Non-profit entity (
received less than $750,000 in federal assistance i.e. federal funds, grants or awards)
Foreign entity
For Profit entity
Governmental entity
ORSP July 2016 (v.3)
SUBRECIPIENT COMMITMENT FORM
!
SECTION D – COMMENTS (URL link to F&A Rate Agreement, etc.)
APPROVED FOR SUBRECIPIENT
The information, certifications and representations above have been read, signed and made by an authorized official of the Subrecipient
named herein. The appropriate programmatic and administrative personnel involved in the application are aware of funding agency’s
policy in regard to subaward and are prepared to establish the necessary inter-institutional agreements consistent with those policies. Any
work begun and/or expenses incurred prior to the execution of a subaward are at the Subrecipient’s own risk.
Signature of Subrecipient’s Authorized Official
Legal Name of Subrecipient’s Organization/Institution
Name and Title of Authorized Official
Address
Email
City, State, Zip+4
Phone
Federal Employee Identification Number (EIN)
Date
DUNS or DUNS+4 Number
Subrecipient’s Congressional District (i.e. MD-007)
Is the Subrecipient owned or controlled by a parent entity? Yes No
If “Yes”, please provide the following:
Parent Entity Legal Name:
Parent Entity Address, City, State, Zip:
Parent Entity Congressional District:
Parent Entity DUNS:
Parent Entity EIN:
ORSP July 2016 (v.3)
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Uwg Subrecipient Commitment Form Subrecipient Commitment Form

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 March 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document