UNIVERSITY OF VIRGINIA INTERNAL PROPOSAL APPROVAL FORM
FOR NIH E-SNAP SUBMISSIONS ONLY
School Proposal #
School/Dept. Name:
Principal Investigator Name:
PI Email:
Project Number
Award Number
Project Owning Org #
Award Owning Org #
Sponsor Name
National Institutes of Health (NIH)
Proposal Type
Continuation
Title of Project
Proposal Period From:
to
Summary of Costs for Proposal Period:
Sponsor Deadline:
Date:
Time:
Direct Costs
Indirect Costs
Total Sponsor Costs
Dept Deadline:
Date:
Time:
Cost Sharing
Total Budget Cost
% Cost Sharing
PRINCIPAL INVESTIGATOR / PROGRAM DIRECTOR'S STATEMENT
1.
A)
B)
YES
NO
NA
i) Does the proposal involve human subjects? If yes, attach IRB approval or explain.
ii) If the proposal involves human subjects, does it also involve human fetal tissue? If yes, attach IRB approval or explain.
If the answer to 1. A) is YES, have all key personnel completed UVa's CITI on-line Human Subjects training module
http://www.virginia.edu/vpr/irb/hsr/citi.html? For additional information, refer to http://www.virginia.edu/vpr/irb/.
2.
Will animals be required? If yes, attach approved protocol or explain.
3.
A)
Will the proposal involve the use of radioactive materials?
B)
Will the proposal involve the generation of hazardous chemical waste?
C)
Has the Office of Environmental Health and Safety been notified if the answer to A or B above is Yes?
Will the proposal involve the use of human-derived materials, infection micro-organisms, recombinant DNA or biological
toxins? Note: Institutional Biosafety Committee (IBC) registration is required PRIOR to use of any of these
materials. Please provide approval number if you have one. If you do not have an IBC approval number, you
may initiate the approval process by completing an Online IBC Registration Form.
Has there been a change in the financial interests of you, other program personnel, and/or relevant family members since the
last award budget period in the sponsoring organization to which this proposal is being submitted. If YES, explain on page two
of this form.
For assistance, refer to UVa Objectivity in Research Policy information at the following websites:
http://www.virginia.edu/researchandpublicservice/research/researchpol/objectivity.html and
http://www.virginia.edu/researchandpublicservice/research/researchcom/researchcom.html
D)
4.
5.
6.
7.
Have all professional staff involved in the proposed project signed the University Patent Agreement? If NO or uncertain, contact
the Office of the Vice President for Research and Public Service to verify.
Are there any project personnel presently debarred, suspended, or proposed for debarment by any Federal agency? If YES,
the proposal should include an explanation.
Is there any implied release time from teaching activities? If yes, attach explanation.
By signing below, the PI makes the following certifications: (1) that the information submitted within the application is true, complete and accurate to the best
of the PI's knowledge; (2) that any false, fictitious, or fraudulent statements or claims may subject the PI to criminal, civil, or administrative penalties; and (3)
that the PI agrees to accept responsibility for the scientific conduct of the project and to provide the required progress reports if a grant is awarded as a result
of the application.
PI Signature:
Date:
DEPARTMENT CHAIR'S AND DEAN'S STATEMENTS: Except as noted below, we concur with the submission of this proposal, which is consistent with the
education and research objectives of the Department and School, and agree:
1.
2.
To release the designated faculty for the effort indicated.
That cost sharing is reasonable and appropriate for this program.
3.
That adequate space will be made available for the proposed program.
That in the event of a sponsor refusing to pay due to a non-performance or default, the department will be responsible for any outstanding financial
obligations (F&A recoveries will be backed off non-paid expenses.)
4.
Department Chair Signature:
Date:
Dean of School Signature:
Date:
Comments:
APPROVED FOR THE UNIVERSITY OF VIRGINIA BY:
Form SP-23E OSP (Revised 03.12.2012)
Date:
1
UNIVERSITY OF VIRGINIA INTERNAL PROPOSAL APPROVAL FORM
FOR NIH E-SNAP SUBMISSIONS ONLY
PART TWO
INFORMATION FOR CENTRAL ADMINISTRATOR USE IN REVIEWING PROPOSALS
1.
Attach internal budget showing anticipated expenditure of next year’s funding. Explain any deviation from UVA’s approved fringe
benefits rates and salary (or wage) rates for faculty, staff and students below.
YES
2.
Have central service rates been verified as current? Attach rate documentation. If “no,” explain.
3.
Does the budget include cost items subject to CAS not previously approved? If “yes,” complete and attach
Part Three of this form.
4.
Does the budget include cost sharing not previously disclosed? If “yes,” complete Part Four of this form.
5.
Have the necessary clearances been obtained from participating departments or schools?
If "no", explain below
6.
Are there any graduate students paid $5,000 or more in a year?
7.
If the response to 6. is “yes,” is tuition remission (or in-state equivalent)/health insurance included?
.
8.
Does the proposal include a subcontract?
NO
NA
SNAP QUESTIONS WITH GUIDANCE NOTES

Has there been a change in the other support of key personnel since the last reporting period?
Answer “yes” if there has been a change in active support of key personnel only. If “yes” provide a complete,
annotated Other Support statement indicating what has changed since the prior budget period.

Will there be, in the next budget period, a significant change in the level of effort of the PI or other personnel
designated in the Notice of Grant Award from what was approved for the project?
A significant change is defined as a 25% or greater reduction of effort. If the answer is “yes” then an
explanation is necessary.

Is it anticipated that an estimated unobligated balance (including prior year carryover) will be greater than 25
percent of the current year’s budget?
If “yes,” an explanation as to why the balance exists is required.
Explanatory Notes:
A review has been made to insure that University Procedures for preparing proposals have been considered and the aboverequired actions have been taken.
Research Administrator Signature:
Form SP-23E OSP (Revised 03.12.2012)
Date:
2
UNIVERSITY OF VIRGINIA INTERNAL PROPOSAL APPROVAL FORM
FOR NIH E-SNAP SUBMISSIONS ONLY
I.
PART THREE
JUSTIFICATION FOR COST ACCOUNTING STANDARDS EXCEPTION REQUEST
Provide a complete justification below for any costs normally classified as Facilities and Administrative (F&A) / indirect costs for which
there is a specific purpose to now direct charge against a Federal or Federal flow-through project. Justification must be related to the
proposal, the purpose of the project, and its technical/scientific aims. Refer to the following Policies and guidance in documenting
these exceptions:
1. UVA Policy VIII.A.6 at http://www.virginia.edu/finance/polproc/pol/viiia6.html
2. UVA Policy VIII.C.1.A at http://www.virginia.edu/finance/polproc/pol/viiic1a.html
3. Cost Accounting Standards Guidelines at http://www.virginia.edu/sponsoredprograms/casonlinedoc.html
If insufficient space on this form, attach additional documentation as needed.
Signatory approvals from the Principal Investigator, Department Chair, Department/School Research Administrator and the
Office of Sponsored Programs are required.
Estimated Quantity
Item Description
Estimated Cost
(Required for items easily identified such as
computers and related peripherals)
Please provide responses to the following for each cost item noted above (multiple items can be combined in a single
response). Attach additional pages as necessary.
1.
Specific Benefit to Project Purpose/Goals: How do stated aims/goals and the overall purpose of the project support
these items as direct costs? (Ex. To complete the mail survey of 3,000 participants, entry and tabulation of data is
necessary along with envelopes, stamps, and 1 computer).
2.
Cost Allocation/Usage – Other Than Personnel Services: What percentage of the item’s use will directly contribute
to completion of project goals/outcomes? (Ex. 100% of the office supplies and postage will be used to complete the
mail survey; 90% of the computer’s usage will be related to entering and storing survey results).
3.
Cost Allocation/Usage – Administrative & Clerical Salary/Fringe: How is the employee(s) contributing directly to
the stated project goals/outcomes, above and beyond normal or routine duties? (Ex. 20% of the Departmental
Administrator’s time will be devoted to data entry/tabulation and conduct of the survey).
II.
Transaction Controls: This functionality has been implemented to assist with costing matters on 1) Federal and Federal flow-through
projects; 2) Training and Fellowship projects; and 3) External Subawards. Below is a partial list of expenditure types for which these
controls have been established. For a complete list, visit:
http://www.virginia.edu/sponsoredprograms/Transaction_Controls_Expenditure_Type_Templates.xls
If you wish to direct charge items not specifically listed, check the “Other” box, note the expenditure type and provide justification
above.
Eq Capital Voice & Data
Eq Non-Capital Desktop/Mobile Comp
Eq Non-Capital Library
Eq Non-Capital Other Comp Equ
Eq Non-Capital Office & Furniture
Eq Non-Capital Voice & Data
Library Books
Supplies, Books (Non-Library)
Supplies, Educational
Supplies, Computer Operating
Supplies, Office
Supplies, Food Svc
Salary, Faculty (TRAINING GRANTS AND FELLOWSHIPS ONLY)
Other (List Expenditure Type):
Principal Investigator Name:
Svcs, Memberships to Orgs
Svcs, Subscrip, Publications
Svcs, Computer Software Maintenance
Svcs, Telecom, Cell, Internet
Svcs, Catering
Svcs, U.S. Postal
Department/School:
PrincipaI Investigator Signature:
Date:
Department Chair Signature:
Date:
Department/School Research
Administrator Signature:
Date:
OSP Approval Signature:
Date:
Federal sponsors in their reviews of costs incurred can choose to disallow costs that are not adequately supported by proper allocation, item allowability
and documentation. Responsibility for any disallowed costs reside at the Department/School level.
Form SP-23E OSP (Revised 03.12.2012)
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UNIVERSITY OF VIRGINIA INTERNAL PROPOSAL APPROVAL FORM
FOR NIH E-SNAP SUBMISSIONS ONLY
PART FOUR
EFFORT AND COST SHARE COMMITMENTS
For OSP Use: ________________________
INSTRUCTIONS:
Project/Award Number
1.
Fill out this information if providing any salary/wage and/or OTPS cost share commitments toward this project.
2.
Complete one form for each year of cost share, unless there are no variations throughout the project’s life.
3.
Exclude salary cap cost share from this form.
PI Name:
Is Cost Share?:
PI Dept./School:
Mandated
Voluntary
Minimum Effort
For Project Budget Years:
to
(See Policy FIN-028)
A. Salary and Wage Detail (Effort Commitments)
Name
Employee
Number
Employee Type (Check one)
9 mo.
12 mo.
SOM
Faculty
Faculty Faculty
Classified
Staff
Student
% Cost
Share
Effort
Salary/Wages
($)
Subtotal
Total Fringe Benefits (associated with salary/wage above)
Total
B. Other Than Personnel Services (OTPS)
Type of Cost Share
Equipment (describe):
Travel
Supplies
Unrecovered Facilities & Administrative Costs
Third Party/In-Kind (describe):
Other (please explain)
Source of Cost Share
(Award number only)
Amount of
Cost Share ($)
NOT APPLICABLE
Total
This document commits your department/school to funding the cost share listed above from sources other than this sponsored program or any other federally
sponsored program.
Department Chair Signature: _________________________________________________ Date: _
(required for commitment of department resources)
_________
Dean of School Signature: ____________________________________________________ Date: __
_________
(required for commitment of school resources)
Form SP-23E OSP (Revised 03.12.2012)
4