the HJF Institutional Data Sheet

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Institutional Data for Grant Applications

(Revised October 2011)

Applicant Institution/Grantee

The Henry M. Jackson Foundation for the

Advancement of Military Medicine, Inc. (HJF)

6720-A Rockledge Drive, Suite 100

Bethesda, Maryland 20817

Phone: (240) 694-2000

Fax: (240) 694-3100

Authorized Signature for Grants and Cooperative Agreements-Office of Sponsored

Programs Department(check with your Grants Specialist):

Amounts up to $250,000: Lexta Taylor, Soso Yang, Claudia Gray-Onque, Harry

Bullerdiek, Gwen Tann, & Lisa Straker (Grants Managers)

Amounts up to $2.5 million: Sudha Srinagesh (Director, Office of Sponsored Programs

Operations)

Amounts up to $20 million: Betsy Folk (Vice President, Office of Sponsored Programs)

No limit: John Lowe (President and Chief Executive Officer)

Contact information for all of people listed above:

Phone: 240-694-4040; fax: 240-694-3111

Email: osp@hjf.org

Financial Officer:

Wayne Clarke, Finance Manager (to receive checks)

John McGann, Disbursement Manager (for invoices)

Contact information for the two people listed:

Phone: 240-694-2000; fax: 240-694-3100

Administrative Official

Your Grants Specialist

Phone: 240-694-4040; fax: 240-694-3111

Email: osp@hjf.org

Facilities & Administrative (F&A)

For Federal Agencies:

Effective 10/1/2010, the IDC rates will be based on Value-Added cost base instead of Modified Total Direct Cost (MTDC).

Other Private Granting Agencies :

As negotiated between the Foundation and the sponsor or as per sponsor requirement

For on- and off-site F&A rates and for F&A approval dates, contact your Grants

Specialist.

Fringe Benefit Rates

For full-time, temporary and intermittent employee fringe rates, contact your Grants

Specialist at 240-694-4040.

Other Relevant information

Federal Employer Identification Number (EIN); Taxpayer Identification Number;

IRS Number: 52-1317896

Public Health Service (PHS) Entity Number: 1521317896A1

Congressional District: 8 Maryland

Department of Health and Human Services (DHHS) Region Number: 3

National Science Foundation (NSF) Institution Number: 4070785000

National Institutes of Health Institutional Profile File Number: 1809301

Dun & Bradstreet (DUNS) Number: 14-467-6566

North American Industry Classification System (NAICS) Number: 541720

Commercial and Government Entity (CAGE) Code: OHC11

Electronic Funds Routing Transit Number (RTN): 026009593

Assurances and Certifications

Human Subjects:

If the project has on- and off-site human subjects, indicate Federalwide

Assurance (FWA) number FWA00000373.

Note: You must always use the FWA number for the Henry M. Jackson

Foundation for the Advancement of Military Medicine (HJF) on applications.

Check with HJF Regulatory Affairs to determine whether “place of work” is affiliated under our FWA number.

Vertebrate Animals:

You must have approval from the Institutional Animal Care and Use Committee

(IACUC) and the Laboratory Animal Review Board (LARB).

Uniformed Services University (USU) assurance number: A3448-01

Inventions and Patents; Program Income Statement: Both as appropriate

Drug-Free Workplace and Smoke-Free Workplace: Yes for both

Age Discrimination (HHS-680): Filed July 20, 1992

Civil Rights (HHS-441), Handicapped Individuals (HHS-641) and

Sex Discrimination (HHS-639-A): All three filed May 31, 1988

Misconduct in Science (PHS-6315): Filed Feb. 16, 2001

Debarment and Suspension, Lobbying, Delinquent Federal Debt: No for all three

For other approvals, follow federal and site policies and procedures as appropriate:

Radiation or radioactive materials

Biohazards and dangerous materials

Controlled substances

Use of central resources

Remodeling or additional space.

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