SUBAWARD REQUEST FORM
Submit completed form to subawards@research.uci.edu. If subrecipient’s scope of work and/or budget has changed, please attach the revised scope of work
and/or budget with your submission.
UCI PRIME AWARD INFORMATION
Principal Investigator:
Department:
Administrative Contact:
Financial Contact:
Prime Sponsor:
Prime Award Number:
Prime Award Instrument:
Grant/Cooperative Agreement
Federal or Non-Federal “contract” (if checked, the term
“subaward” as used on this form will mean “subcontract” and “subrecipient” will mean “subcontractor”)
SUBAWARD INFORMATION
Principal Investigator:
Subrecipient Institution:
Subaward Number (for existing subawards):
Account & Fund:
Subrecipient will perform research involving the following (check all applicable):
☐Human Subjects ☐Recombinant DNA ☐Animal Subjects ☐Stem Cells
REQUESTED SUBAWARD ACTION
☐New Subaward
Period of Performance:
Subaward Amount: $
☐No Cost Time Extension
Revised End Date:
☐Increase Funding by $
Revised Total Subaward Amount: $
Period of Performance:
☐*Decrease Funding by $
Revised Total Subaward Amount: $
Period of Performance:
*If checked, by signing below, I certify that expenses incurred/paid to subcontractor thus far do not exceed the decreased
amount.
☐Other – Explain
SUBAWARD REPORTING REQUIREMENT
☐Annual ☐Semi-Annual ☐Quarterly
What was the basis for selection of the subrecipient?
☐Competitive Solicitation
☐*Sole Source (based upon unique qualifications, facilities, equipment, know how, or integral part of a collaborative research
team)
*If checked AND request is for a “Subcontract,” complete the Sole Source Justification Form)
Will this subrecipient relationship result in an agreement between the University and (1) a current or former University employee
or (2) a current employee’s near relative (defined in UC Business and Finance Bulletin 43) or (3) an entity in which you or your
near relative has a financial interest?
☐Yes
☐No
UCI Principal Investigator Verification
I have reviewed the subrecipient’s budget and believe that costs stated therein to be reasonable and appropriate for the work to be
performed. If this request is for an amendment to an existing subaward, I further certify that the subrecipient’s performance goals
were met and that progress to date is satisfactory and in keeping with the statement of work.
Name:
Signature:
University of California, Irvine
Revised June 2015
Date:
Office of Research – Sponsored Projects