University of Minnesota
INSTRUCTIONS TO SUBCONTRACTORS
New and Revised NIH Grant Applications
Please complete the following documents and email them to Anne Everett and Charlotte Flipp at
the email addresses listed on page 2. When completing these pages, please do not use
Headers and Footers. Please provide the electronic versions of signed forms via email. For
your convenience, templates in MS Word format are included at the bottom of this document.
Downloadable form files and the full set of instructions for the 398 booklet (rev. 06/09) can be
found at the following link http://grants1.nih.gov/grants/funding/phs398/phs398.html
Email the following documents to Charlotte Flipp and Anne Everett (see contact
information on next page).
 Consortium Statement: (See Attached). A consortium statement of participation that
states your institution’s agreement to participate in this project follows this checklist. This
statement must be signed by your institution’s authorized business official. Please put this
statement on your institutional letterhead and e-mail to Charlotte Flipp & Anne Everett at the
e-mail addresses listed on the next page.
 PHS 398 Subcontract Budget – Prepare for each year of project
 Grants.gov Subaward Budget – See Attached grants.gov subaward file –
Prepare for each year of the project and attach the budget justification where indicated.
 PHS 398 Budget Justification - Please justify all costs thoroughly, providing detailed
information on any variance in costs by year. Please describe salary escalation, fringe rates
used, and F&A rate(s) and applicable date of DHHS agreement (as applicable). Please
note/use new person-month format (versus the previous percent of effort).
 PHS 398 Biographical Sketch –Please provide for each of the key personnel who will be
working on the proposed project. Please note the 4-page limitation for all components,
including the table at beginning of the document. No headers or footers.
 PHS 398 Resources & Environment - Resources Format Page
Please provide the relevant information for your institution/performance site. Use additional
pages as necessary. (No headers or footers)
 Letter of Support – Email letter of support directly to the PI of the project.
 PHS 398 Checklist
All materials should be emailed to Charlotte Flipp and Anne Everett (see email addresses
below). Signed original consortium statement should be sent to Charlotte Flipp/Anne Everett as
well. If you have any questions concerning the preparation or submission of these materials,
please contact:
CONTACT:
Charlotte Flipp
Executive Assistant
Epidemiology & Community Health
University of Minnesota
1300 South Second Street,
Suite 300 West Bank Office Bldg.
Tel: 612-626-8807
Fax: 612-624-5029
Email: flipp001@umn.edu
CONTACT:
Anne Miles Everett
Executive Assistant
Epidemiology & Community Health
University of Minnesota
1300 South Second Street,
Suite 300 West Bank Office Bldg.
Tel: 612-626-8814
Fax: 612-624-5029
Email: evere002@umn.edu
STATEMENT OF INTENT TO ESTABLISH A CONSORTIUM AGREEMENT
Date:
Application Title:
Prime Institution: Regents of the University of Minnesota
Principal Investigator:
Proposed Project Period:
Proposed Project Budget Total: $ Direct$
Indirect$
Consortium Institution:
Consortium PI:
Address1:
Address2:
City:
State:
Zip:
Consortium Institution DUNS Number:
DHHS Agreement:
Congressional District and County:
NIH Commons Profile Number:
Organization Type:
Entity Identification Number:
Cognizant Audit Agency:
Contact:
Phone Number:
Enter Your Institution Name Here agrees to participate in the above named proposal. The
appropriate programmatic and administrative personnel involved in this grant application are
aware of the federal consortium agreement policy and are prepared to establish the necessary
inter-institutional agreement(s) consistent with that policy.
ASSURANCES/CERTIFICATIONS • In signing this statement, the authorized organizational
representative agrees to comply with the following policies, assurances and/or certifications
when applicable. If unable to certify compliance, where applicable, provide an explanation and
place it after this page.
• Human Subjects Research • Research Using Human Embryonic Stem Cells • Research on
Transplantation of Human Fetal Tissue • Women and Minority Inclusion Policy • Inclusion of
Children Policy •Vertebrate Animals • Debarment and Suspension • Drug- Free Workplace
(applicable to new [Type 1] or revised/resubmission [Type 1] applications only) • Lobbying •
Non-Delinquency on Federal Debt • Research Misconduct • Civil Rights (Form HHS 441 or HHS
690) • Handicapped Individuals (Form HHS 641 or HHS 690) • Sex Discrimination (Form HHS
639-A or HHS 690) • Age Discrimination (Form HHS 680 or HHS 690) • Recombinant DNA
Research, Including Human Gene Transfer Research • Financial Conflict of Interest • Smoke
Free Workplace • Prohibited Research • Select Agent Research • PI Assurance
APPLICANT ORGANIZATION CERTIFICATION AND ACCEPTANCE: I certify that the
statements herein are true, complete and accurate to the best of my knowledge, and accept the
obligation to comply with Public Health Services terms and conditions if a grant is awarded as a
result of this application. I am aware that any false, fictitious, or fraudulent statements or claims
may subject me to criminal, civil, or administrative penalties.
Official Authorized to sign for Consortium Institution
By:
Signature
Type Name
Title
Date