APPLICATION FOR FEDERAL ASSISTANCE SF 424 (R&R) 3. DATE RECEIVED BY STATE State Application Identifier. 1. TYPE OF SUBMISSION* 4.a. Federal Identifier

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1 OMB Number: Expiration Date: 10/31/2019 APPLICATION FOR FEDERAL ASSISTANCE SF 424 (R&R) 3. DATE RECEIVED BY STATE State Application Identifier 1. TYPE OF SUBMISSION* 4.a. Federal Identifier Pre-application Application Changed/Corrected Application b. Agency Routing Number 2. DATE SUBMITTED Application Identifier c. Previous Grants.gov Tracking Number 5. APPLICANT INFORMATION Organizational DUNS*: Legal Name*: Board of Trustees of the Leland Stanford Junior University Department: Research Management Group Division: School of Medicine Street1*: 3172 Porter Drive Street2: City*: County: State*: Palo Alto CA: California Province: Country*: USA: UNITED STATES ZIP / Postal Code*: Person to be contacted on matters involving this application Prefix: First Name*: Holly Middle Name: Last Name*: Osborne Suffix: Position/Title: Street1*: Street2: City*: County: State*: Research Process Manager 3172 Porter Drive Palo Alto CA: California Province: Country*: USA: UNITED STATES ZIP / Postal Code*: Phone Number*: Fax Number: hosborne@stanford.edu 6. EMPLOYER IDENTIFICATION NUMBER (EIN) or (TIN)* A1 7. TYPE OF APPLICANT* O: Private Institution of Higher Education Other (Specify): Small Business Organization Type Women Owned Socially and Economically Disadvantaged 8. TYPE OF APPLICATION* If Revision, mark appropriate box(es). New Resubmission A. Increase Award B. Decrease Award C. Increase Duration Renewal Continuation Revision D. Decrease Duration E. Other (specify) : Is this application being submitted to other agencies?* Yes No What other Agencies? 9. NAME OF FEDERAL AGENCY* National Institutes of Health 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT* Test Application 12. PROPOSED PROJECT Start Date* Ending Date* 04/01/ /31/ CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER TITLE: 13. CONGRESSIONAL DISTRICTS OF APPLICANT CA-018 Page 1

2 SF 424 (R&R) APPLICATION FOR FEDERAL ASSISTANCE Page PROJECT DIRECTOR/PRINCIPAL INVESTIGATOR CONTACT INFORMATION Prefix: First Name*: Linda Middle Name: Last Name*: Murtagh Suffix: Position/Title: Associate Professor Organization Name*: Stanford University Department: Medicine Division: School of Medicine Street1*: 3172 Porter Drive Street2: City*: County: State*: Palo Alto CA: California Province: Country*: USA: UNITED STATES ZIP / Postal Code*: Phone Number*: Fax Number: *: lmurtagh@stanford.edu 15. ESTIMATED PROJECT FUNDING a. Total Federal Funds Requested* $3,849, b. Total Non-Federal Funds* $0.00 c. Total Federal & Non-Federal Funds* $3,849, d. Estimated Program Income* $ IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER PROCESS?* a. YES THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER PROCESS FOR REVIEW ON: DATE: b. NO PROGRAM IS NOT COVERED BY E.O ; OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW 17. By signing this application, I certify (1) to the statements contained in the list of certifications* and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances * and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001) I agree* * The list of certifications and assurances, or an Internet site where you may obtain this list, is contained in the announcement or agency specific instructions. 18. SFLLL or OTHER EXPLANATORY DOCUMENTATION File Name: 19. AUTHORIZED REPRESENTATIVE Prefix: First Name*: Holly Middle Name: Last Name*: Osborne Suffix: Position/Title*: Research Process Manager Organization Name*: Stanford Universtiy Department: Research Management Group Division: School of Medicine Street1*: 3172 Porter Drive Street2: City*: County: State*: Contact PD/PI: Murtagh, Linda Palo Alto CA: California Province: Country*: USA: UNITED STATES ZIP / Postal Code*: Phone Number*: Fax Number: *: hosborne@stanford.edu Signature of Authorized Representative* Completed on submission to Grants.gov Date Signed* 07/18/ PRE-APPLICATION File Name: Mime Type: 21. COVER LETTER ATTACHMENT File Name:Cover_Letter.pdf Mime Type: application/pdf Page 2

3 424 R&R and PHS-398 Specific Table Of Contents SF 424 R&R Cover Page...1 Table of Contents...3 Performance Sites...4 Research & Related Other Project Information...5 Project Summary/Abstract(Description)...6 Project Narrative...7 Facilities & Other Resources...8 Equipment...9 Other Attachments...10 Other_Attachments...10 Research & Related Senior/Key Person...11 Research & Related Budget Year Research & Related Budget Year Research & Related Budget Year Research & Related Budget Year Research & Related Budget Year Budget Justification...33 Research & Related Cumulative Budget...34 Research & Related Budget - Consortium Budget (Subaward 1)...35 Total Direct Costs Less Consortium F&A...52 PHS398 Cover Page Supplement...53 PHS 398 Research Plan...55 Specific Aims...56 Research Strategy...57 Human Subjects Section...58 Protection of Human Subjects...58 Inclusion of Women and Minorities...59 PHS Inclusion Enrollment Report...60 Inclusion of Children...61 Vertebrate Animals...62 Select Agent Research...63 Bibliography & References Cited...64 Consortium/Contractual Arrangements...65 Letters of Support...66 Resource Sharing Plan(s)...67 Authentication of Key Biological and/or Chemical Resources...70 Table of Contents Page 3

4 OMB Number: Expiration Date: 10/31/2019 Project/Performance Site Location(s) Project/Performance Site Primary Location Organization Name: STANFORD UNIVERSITY Duns Number: Street1*: STANFORD UNIVERSITY Street2: 3172 PORTER DRIVE City*: STANFORD County: State*: CA: California Province: Country*: USA: UNITED STATES Zip / Postal Code*: Project/Performance Site Congressional District*: I am submitting an application as an individual, and not on behalf of a company, state, local or tribal government, academia, or other type of organization. CA-018 Project/Performance Site Location 1 Organization Name: DUNS Number: I am submitting an application as an individual, and not on behalf of a company, state, local or tribal government, academia, or other type of organization. The Regents of the University of California, San Francisco Street1*: 3333 California Street, Suite 315 Street2: City*: County: State*: Province: Country*: San Francisco CA: California USA: UNITED STATES Zip / Postal Code*: Project/Performance Site Congressional District*: CA-012 Additional Location(s) File Name: Page 4 Funding Opportunity Number: PA Received Date:

5 RESEARCH & RELATED Other Project Information OMB Number: Expiration Date: 10/31/ Are Human Subjects Involved?* Yes No 1.a. If YES to Human Subjects Is the Project Exempt from Federal regulations? Yes No If YES, check appropriate exemption number: If NO, is the IRB review Pending? Yes No IRB Approval Date: Human Subject Assurance Number Are Vertebrate Animals Used?* Yes No 2.a. If YES to Vertebrate Animals Is the IACUC review Pending? Yes No IACUC Approval Date: Animal Welfare Assurance Number D Is proprietary/privileged information included in the application?* Yes No 4.a. Does this project have an actual or potential impact - positive or negative - on the environment?* Yes No 4.b. If yes, please explain: 4.c. If this project has an actual or potential impact on the environment, has an exemption been authorized or an Yes No environmental assessment (EA) or environmental impact statement (EIS) been performed? 4.d. If yes, please explain: 5. Is the research performance site designated, or eligible to be designated, as a historic place?* Yes No 5.a. If yes, please explain: 6. Does this project involve activities outside the United States or partnership with international Yes No collaborators?* 6.a. If yes, identify countries: 6.b. Optional Explanation: Filename 7. Project Summary/Abstract* Abstract.pdf 8. Project Narrative* Project_Narrative.pdf 9. Bibliography & References Cited Bibliography.pdf 10.Facilities & Other Resources Facilities_and_Other_Resources.pdf 11.Equipment Equipment.pdf 12. Other Attachments Other_Attachments.pdf Page 5 Funding Opportunity Number: PA Received Date:

6 7. Project Summary/Abstract PI/Department is responsible for this document. 30 Lines of text maximum. Instructions for Abstract Instructions to Format Attachments NIH Page Limits Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Project Summary/Abstract Page 6

7 8. Project Narrative PI/Department is responsible for this document. 3 Sentences Max. Instructions for Project Narrative Instructions to Format Attachments Page Limit Guide Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Project Narrative Page 7

8 10. Facilities & Other Resources Instructions for Facilities Instructions to Format Attachments PI/Department is responsible for obtaining this document for all locations of where work will be performed (Stanford locations & Sub-Site locations). Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Facilities & Other Resources Page 8

9 11. Equipment PI/Department is responsible for obtaining this document for all locations of where work will be performed (Stanford locations & Sub-Site locations). Instructions for Equipment Instructions to Format Attachments Add this statement to the document: Equipment is available for use on this project without any direct cost to the sponsor Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Equipment Page 9

10 12. Other Attachments PI/Department is responsible for this document. ** NIH may reject application if instructions aren t followed ** Attach a file to provide additional information only in accordance with the FOA and/or agency-specific instructions. If applicable, attach a "Foreign Justification" here. (See Question 6 above). Instructions for Other Attachments Instructions to Format Attachments Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Other_Attachments Page 10

11 RESEARCH & RELATED Senior/Key Person Profile (Expanded) OMB Number: Expiration Date: 10/31/2019 PROFILE - Project Director/Principal Investigator Prefix: First Name*: Linda Middle Name Last Name*: Murtagh Suffix: Position/Title*: Organization Name*: Department: Division: Street1*: Street2: City*: County: State*: Province: Associate Professor Stanford University Medicine School of Medicine 3172 Porter Drive Palo Alto CA: California Country*: USA: UNITED STATES Zip / Postal Code*: Phone Number*: Fax Number: *: lmurtagh@stanford.edu Credential, e.g., agency login: murtagh.linda Project Role*: PD/PI Degree Type: Other Project Role Category: Degree Year: Attach Biographical Sketch*: File Name: Biosketches.pdf Attach Current & Pending Support: File Name: Other_Support.pdf Page 11

12 PROFILE - Senior/Key Person Prefix: First Name*: Jane Middle Name Last Name*: Smith Suffix: Position/Title*: Assistant Professor Organization Name*: The Regents of the University of California, San Francisco Department: Medicine Division: Street1*: 3333 California Street, Suite 315 Street2: City*: San Francisco County: State*: CA: California Province: Country*: USA: UNITED STATES Zip / Postal Code*: Phone Number*: Fax Number: *: lmurtagh@stanford.edu Credential, e.g., agency login: Project Role*: Co-Investigator Other Project Role Category: Degree Type: Degree Year: Attach Biographical Sketch*: File Name: Biosketches_Subaward.pdf Attach Current & Pending Support: File Name: Page 12

13 Biosketches PI/Department is responsible for obtaining this document for all those listed under Sr/Key Person Profile section. Biosketch Instructions Biosketch Format Pages, Instructions & Samples Special Note: Research Support section of Biosketch These instructions apply to all applicants who are completing the "Research Support" section. List ongoing and completed research projects from the past three years that you want to draw attention to. Briefly indicate the overall goals of the projects and your responsibilities. Do not include the number of person months or direct costs. Do not confuse "Research Support" with "Other Support." Other Support information is not collected at the time of application submission. Biosketches Page 13

14 Research Support: As part of the Biosketch section of the application, "Research Support" highlights your accomplishments, and those of your colleagues, as scientists. This information will be used by the reviewers in the assessment of each your qualifications for a specific role in the proposed project, as well as to evaluate the overall qualifications of the research team. Other Support: NIH staff may request complete and up-to-date "other support" information from you as part of Just-in-Time information collection. Do not use Research Support section of Biosketch as Other Support. Do not use Other Support as Research Support section of Biosketch. Instructions to Format Attachments Page Limit Guide Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Biosketches Page 14

15 Biosketches PI/Department is responsible for obtaining this document for all those listed under Sr/Key Person Profile section. Biosketch Instructions Biosketch Format Pages, Instructions & Samples Special Note: Research Support section of Biosketch These instructions apply to all applicants who are completing the "Research Support" section. List ongoing and completed research projects from the past three years that you want to draw attention to. Briefly indicate the overall goals of the projects and your responsibilities. Do not include the number of person months or direct costs. Do not confuse "Research Support" with "Other Support." Other Support information is not collected at the time of application submission. Biosketches Page 15

16 Research Support: As part of the Biosketch section of the application, "Research Support" highlights your accomplishments, and those of your colleagues, as scientists. This information will be used by the reviewers in the assessment of each your qualifications for a specific role in the proposed project, as well as to evaluate the overall qualifications of the research team. Other Support: NIH staff may request complete and up-to-date "other support" information from you as part of Just-in-Time information collection. Do not use Research Support section of Biosketch as Other Support. Do not use Other Support as Research Support section of Biosketch. Instructions to Format Attachments Page Limit Guide Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Biosketches Page 16

17 Other Support PI/Department is responsible for obtaining this document for all those listed under Sr/Key Person Profile section. Do not use the "Current & Pending Support" attachment upload for NIH or other PHS agency submissions unless otherwise specified in the FOA (see exception for career development applications in the Career Development-specific instructions below). Additional Instructions for Career Development: Who must complete the "Current & Pending Support" field: For mentored career development award applications, you must include "Current and Pending Support" pages for each of the mentor and co-mentor(s). You do not need to include "Current and Pending Support" pages for the candidate. Do not include information on "percent effort/person months" or on "overlap." Instructions for Current & Pending Support Supplemental Instructions, Part III, Section 1.8: Other Support Current and Pending Support Format Page Special Note: Research Support section of Biosketch Do not confuse "Research Support" with "Other Support." Other Support information is not collected at the time of application submission. Research Support: As part of the Biosketch section of the application, "Research Support" highlights your accomplishments, and those of your colleagues, as scientists. This information will be used by the reviewers in the assessment of each your qualifications for a specific role in the proposed project, as well as to evaluate the overall qualifications of the research team. Other Support: NIH staff may request complete and up-to-date "other support" information from you as part of Just-in-Time information collection. Instructions to Format Attachments Do not use Research Support section of Biosketch as Other Support. Do not use Other Support as Research Support section of Biosketch. Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Current and Pending Support Page 17

18 RESEARCH & RELATED BUDGET - SECTION A & B, Budget Period 1 OMB Number: Expiration Date: 06/30/2016 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Enter name of Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 1 A. Senior/Key Person # Prefix First Name* Middle Last Name* Suffix Project Role* Base Calendar Academic Summer Requested Fringe Funds Requested ($)* Name Salary ($) Months Months Months Salary ($)* Benefits ($)* 1. Linda Murtagh PD/PI 187, , , , Total Funds Requested for all Senior Key Persons in the attached file Additional Senior Key Persons: File Name: Total Senior/Key Person 24, Mime Type: B. Other Personnel Number of Personnel* Project Role* Calendar Months Academic Months Summer Months Requested Salary ($)* Fringe Benefits* Funds Requested ($)* 2 Post Doctoral Associates , , , Graduate Students , , , Undergraduate Students Secretarial/Clerical 2 Research Assistant , , , Total Number Other Personnel Total Other Personnel 341, RESEARCH & RELATED Budget {A-B} (Funds Requested) Total Salary, Wages and Fringe Benefits (A+B) 366, Page 18

19 RESEARCH & RELATED BUDGET - SECTION C, D, & E, Budget Period 1 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 1 C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment Item Funds Requested ($)* Total funds requested for all equipment listed in the attached file Total Equipment 0.00 Additional Equipment: File Name: Mime Type: D. Travel Funds Requested ($)* 1. Domestic Travel Costs ( Incl. Canada, Mexico, and U.S. Possessions) 25, Foreign Travel Costs Total Travel Cost 25, E. Participant/Trainee Support Costs Funds Requested ($)* 1. Tuition/Fees/Health Insurance 2. Stipends 3. Travel 4. Subsistence 5. Other: Number of Participants/Trainees Total Participant Trainee Support Costs 0.00 RESEARCH & RELATED Budget {C-E} (Funds Requested) Page 19

20 RESEARCH & RELATED BUDGET - SECTIONS F-K, Budget Period 1 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 1 F. Other Direct Costs Funds Requested ($)* 1. Materials and Supplies 30, Publication Costs 2, Consultant Services 4. ADP/Computer Services 5. Subawards/Consortium/Contractual Costs 50, Equipment or Facility Rental/User Fees 20, Alterations and Renovations 8. Animal Care 5, Total Other Direct Costs 107, G. Direct Costs Funds Requested ($)* Total Direct Costs (A thru F) 498, H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($)* 1. MTDC , , MTDC , , Total Indirect Costs 271, Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) Office of Naval Research, Linda Shipp, (703) I. Total Direct and Indirect Costs Funds Requested ($)* Total Direct and Indirect Institutional Costs (G + H) 769, J. Fee Funds Requested ($)* K. Budget Justification* File Name: BudgetJustification.pdf Mime Type: application/pdf RESEARCH & RELATED Budget {F-K} (Funds Requested) (Only attach one file.) Page 20

21 RESEARCH & RELATED BUDGET - SECTION A & B, Budget Period 2 OMB Number: Expiration Date: 06/30/2016 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Enter name of Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 2 A. Senior/Key Person # Prefix First Name* Middle Last Name* Suffix Project Role* Base Calendar Academic Summer Requested Fringe Funds Requested ($)* Name Salary ($) Months Months Months Salary ($)* Benefits ($)* 1. Linda Murtagh PD/PI 187, , , , Total Funds Requested for all Senior Key Persons in the attached file Additional Senior Key Persons: File Name: Total Senior/Key Person 24, Mime Type: B. Other Personnel Number of Personnel* Project Role* Calendar Months Academic Months Summer Months Requested Salary ($)* Fringe Benefits* Funds Requested ($)* 2 Post Doctoral Associates , , , Graduate Students , , , Undergraduate Students Secretarial/Clerical 2 Research Assistant , , , Total Number Other Personnel Total Other Personnel 341, RESEARCH & RELATED Budget {A-B} (Funds Requested) Total Salary, Wages and Fringe Benefits (A+B) 366, Page 21

22 RESEARCH & RELATED BUDGET - SECTION C, D, & E, Budget Period 2 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 2 C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment Item Funds Requested ($)* Total funds requested for all equipment listed in the attached file Total Equipment 0.00 Additional Equipment: File Name: Mime Type: D. Travel Funds Requested ($)* 1. Domestic Travel Costs ( Incl. Canada, Mexico, and U.S. Possessions) 25, Foreign Travel Costs Total Travel Cost 25, E. Participant/Trainee Support Costs Funds Requested ($)* 1. Tuition/Fees/Health Insurance 2. Stipends 3. Travel 4. Subsistence 5. Other: Number of Participants/Trainees Total Participant Trainee Support Costs 0.00 RESEARCH & RELATED Budget {C-E} (Funds Requested) Page 22

23 RESEARCH & RELATED BUDGET - SECTIONS F-K, Budget Period 2 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 2 F. Other Direct Costs Funds Requested ($)* 1. Materials and Supplies 30, Publication Costs 2, Consultant Services 4. ADP/Computer Services 5. Subawards/Consortium/Contractual Costs 50, Equipment or Facility Rental/User Fees 20, Alterations and Renovations 8. Animal Care 5, Total Other Direct Costs 107, G. Direct Costs Funds Requested ($)* Total Direct Costs (A thru F) 498, H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($)* 1. MTDC , , MTDC , , Total Indirect Costs 271, Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) Office of Naval Research, Linda Shipp, (703) I. Total Direct and Indirect Costs Funds Requested ($)* Total Direct and Indirect Institutional Costs (G + H) 769, J. Fee Funds Requested ($)* K. Budget Justification* File Name: BudgetJustification.pdf Mime Type: application/pdf RESEARCH & RELATED Budget {F-K} (Funds Requested) (Only attach one file.) Page 23

24 RESEARCH & RELATED BUDGET - SECTION A & B, Budget Period 3 OMB Number: Expiration Date: 06/30/2016 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Enter name of Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 3 A. Senior/Key Person # Prefix First Name* Middle Last Name* Suffix Project Role* Base Calendar Academic Summer Requested Fringe Funds Requested ($)* Name Salary ($) Months Months Months Salary ($)* Benefits ($)* 1. Linda Murtagh PD/PI 187, , , , Total Funds Requested for all Senior Key Persons in the attached file Additional Senior Key Persons: File Name: Total Senior/Key Person 24, Mime Type: B. Other Personnel Number of Personnel* Project Role* Calendar Months Academic Months Summer Months Requested Salary ($)* Fringe Benefits* Funds Requested ($)* 2 Post Doctoral Associates , , , Graduate Students , , , Undergraduate Students Secretarial/Clerical 2 Research Assistant , , , Total Number Other Personnel Total Other Personnel 341, RESEARCH & RELATED Budget {A-B} (Funds Requested) Total Salary, Wages and Fringe Benefits (A+B) 366, Page 24

25 RESEARCH & RELATED BUDGET - SECTION C, D, & E, Budget Period 3 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 3 C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment Item Funds Requested ($)* Total funds requested for all equipment listed in the attached file Total Equipment 0.00 Additional Equipment: File Name: Mime Type: D. Travel Funds Requested ($)* 1. Domestic Travel Costs ( Incl. Canada, Mexico, and U.S. Possessions) 25, Foreign Travel Costs Total Travel Cost 25, E. Participant/Trainee Support Costs Funds Requested ($)* 1. Tuition/Fees/Health Insurance 2. Stipends 3. Travel 4. Subsistence 5. Other: Number of Participants/Trainees Total Participant Trainee Support Costs 0.00 RESEARCH & RELATED Budget {C-E} (Funds Requested) Page 25

26 RESEARCH & RELATED BUDGET - SECTIONS F-K, Budget Period 3 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 3 F. Other Direct Costs Funds Requested ($)* 1. Materials and Supplies 30, Publication Costs 2, Consultant Services 4. ADP/Computer Services 5. Subawards/Consortium/Contractual Costs 50, Equipment or Facility Rental/User Fees 20, Alterations and Renovations 8. Animal Care 5, Total Other Direct Costs 107, G. Direct Costs Funds Requested ($)* Total Direct Costs (A thru F) 498, H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($)* 1. MTDC , , MTDC , , Total Indirect Costs 271, Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) Office of Naval Research, Linda Shipp, (703) I. Total Direct and Indirect Costs Funds Requested ($)* Total Direct and Indirect Institutional Costs (G + H) 769, J. Fee Funds Requested ($)* K. Budget Justification* File Name: BudgetJustification.pdf Mime Type: application/pdf RESEARCH & RELATED Budget {F-K} (Funds Requested) (Only attach one file.) Page 26

27 RESEARCH & RELATED BUDGET - SECTION A & B, Budget Period 4 OMB Number: Expiration Date: 06/30/2016 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Enter name of Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 4 A. Senior/Key Person # Prefix First Name* Middle Last Name* Suffix Project Role* Base Calendar Academic Summer Requested Fringe Funds Requested ($)* Name Salary ($) Months Months Months Salary ($)* Benefits ($)* 1. Linda Murtagh PD/PI 187, , , , Total Funds Requested for all Senior Key Persons in the attached file Additional Senior Key Persons: File Name: Total Senior/Key Person 24, Mime Type: B. Other Personnel Number of Personnel* Project Role* Calendar Months Academic Months Summer Months Requested Salary ($)* Fringe Benefits* Funds Requested ($)* 2 Post Doctoral Associates , , , Graduate Students , , , Undergraduate Students Secretarial/Clerical 2 Research Assistant , , , Total Number Other Personnel Total Other Personnel 341, RESEARCH & RELATED Budget {A-B} (Funds Requested) Total Salary, Wages and Fringe Benefits (A+B) 366, Page 27

28 RESEARCH & RELATED BUDGET - SECTION C, D, & E, Budget Period 4 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 4 C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment Item Funds Requested ($)* Total funds requested for all equipment listed in the attached file Total Equipment 0.00 Additional Equipment: File Name: Mime Type: D. Travel Funds Requested ($)* 1. Domestic Travel Costs ( Incl. Canada, Mexico, and U.S. Possessions) 25, Foreign Travel Costs Total Travel Cost 25, E. Participant/Trainee Support Costs Funds Requested ($)* 1. Tuition/Fees/Health Insurance 2. Stipends 3. Travel 4. Subsistence 5. Other: Number of Participants/Trainees Total Participant Trainee Support Costs 0.00 RESEARCH & RELATED Budget {C-E} (Funds Requested) Page 28

29 RESEARCH & RELATED BUDGET - SECTIONS F-K, Budget Period 4 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 4 F. Other Direct Costs Funds Requested ($)* 1. Materials and Supplies 30, Publication Costs 2, Consultant Services 4. ADP/Computer Services 5. Subawards/Consortium/Contractual Costs 50, Equipment or Facility Rental/User Fees 20, Alterations and Renovations 8. Animal Care 5, Total Other Direct Costs 107, G. Direct Costs Funds Requested ($)* Total Direct Costs (A thru F) 498, H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($)* 1. MTDC , , MTDC , , Total Indirect Costs 271, Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) Office of Naval Research, Linda Shipp, (703) I. Total Direct and Indirect Costs Funds Requested ($)* Total Direct and Indirect Institutional Costs (G + H) 769, J. Fee Funds Requested ($)* K. Budget Justification* File Name: BudgetJustification.pdf Mime Type: application/pdf RESEARCH & RELATED Budget {F-K} (Funds Requested) (Only attach one file.) Page 29

30 RESEARCH & RELATED BUDGET - SECTION A & B, Budget Period 5 OMB Number: Expiration Date: 06/30/2016 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Enter name of Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 5 A. Senior/Key Person # Prefix First Name* Middle Last Name* Suffix Project Role* Base Calendar Academic Summer Requested Fringe Funds Requested ($)* Name Salary ($) Months Months Months Salary ($)* Benefits ($)* 1. Linda Murtagh PD/PI 187, , , , Total Funds Requested for all Senior Key Persons in the attached file Additional Senior Key Persons: File Name: Total Senior/Key Person 24, Mime Type: B. Other Personnel Number of Personnel* Project Role* Calendar Months Academic Months Summer Months Requested Salary ($)* Fringe Benefits* Funds Requested ($)* 2 Post Doctoral Associates , , , Graduate Students , , , Undergraduate Students Secretarial/Clerical 2 Research Assistant , , , Total Number Other Personnel Total Other Personnel 341, RESEARCH & RELATED Budget {A-B} (Funds Requested) Total Salary, Wages and Fringe Benefits (A+B) 366, Page 30

31 RESEARCH & RELATED BUDGET - SECTION C, D, & E, Budget Period 5 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 5 C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment Item Funds Requested ($)* Total funds requested for all equipment listed in the attached file Total Equipment 0.00 Additional Equipment: File Name: Mime Type: D. Travel Funds Requested ($)* 1. Domestic Travel Costs ( Incl. Canada, Mexico, and U.S. Possessions) 25, Foreign Travel Costs Total Travel Cost 25, E. Participant/Trainee Support Costs Funds Requested ($)* 1. Tuition/Fees/Health Insurance 2. Stipends 3. Travel 4. Subsistence 5. Other: Number of Participants/Trainees Total Participant Trainee Support Costs 0.00 RESEARCH & RELATED Budget {C-E} (Funds Requested) Page 31

32 RESEARCH & RELATED BUDGET - SECTIONS F-K, Budget Period 5 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: Board of Trustees of the Leland Stanford Junior University Start Date*: End Date*: Budget Period: 5 F. Other Direct Costs Funds Requested ($)* 1. Materials and Supplies 30, Publication Costs 2, Consultant Services 4. ADP/Computer Services 5. Subawards/Consortium/Contractual Costs 50, Equipment or Facility Rental/User Fees 20, Alterations and Renovations 8. Animal Care 5, Total Other Direct Costs 107, G. Direct Costs Funds Requested ($)* Total Direct Costs (A thru F) 498, H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($)* 1. MTDC , , MTDC , , Total Indirect Costs 271, Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) Office of Naval Research, Linda Shipp, (703) I. Total Direct and Indirect Costs Funds Requested ($)* Total Direct and Indirect Institutional Costs (G + H) 769, J. Fee Funds Requested ($)* K. Budget Justification* File Name: BudgetJustification.pdf Mime Type: application/pdf RESEARCH & RELATED Budget {F-K} (Funds Requested) (Only attach one file.) Page 32

33 NIH Resources: NIH SF424 R&R Develop Your Budget Stanford Resources: Overview of Budget Justification Write a Budget Justification Section K Budget Justification Budget Justification Attachment Page 33

34 RESEARCH & RELATED BUDGET - Cumulative Budget Totals ($) Section A, Senior/Key Person 122, Section B, Other Personnel 1,708, Total Number Other Personnel 30 Total Salary, Wages and Fringe Benefits (A+B) 1,830, Section C, Equipment 0.00 Section D, Travel 125, Domestic 125, Foreign 0.00 Section E, Participant/Trainee Support Costs 1. Tuition/Fees/Health Insurance Stipends Travel Subsistence Other Number of Participants/Trainees 0 Section F, Other Direct Costs 537, Materials and Supplies 150, Publication Costs 12, Consultant Services ADP/Computer Services Subawards/Consortium/Contractual Costs 6. Equipment or Facility Rental/User Fees 250, , Alterations and Renovations Other 1 25, Other Other Section G, Direct Costs (A thru F) ,493, Section H, Indirect Costs 1,356, Section I, Total Direct and Indirect Costs (G + H) 3,849, Section J, Fee 0.00 Page 34

35 RESEARCH & RELATED BUDGET - SECTION A & B, Budget Period 1 OMB Number: Expiration Date: 06/30/2016 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Enter name of Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 1 A. Senior/Key Person # Prefix First Name* Middle Last Name* Suffix Project Role* Base Calendar Academic Summer Requested Fringe Funds Requested ($)* Name Salary ($) Months Months Months Salary ($)* Benefits ($)* 1. Jane Smith Co-Investigator 187, , , , Total Funds Requested for all Senior Key Persons in the attached file Additional Senior Key Persons: File Name: Total Senior/Key Person 24, Mime Type: B. Other Personnel Number of Personnel* Project Role* Calendar Months Academic Months Summer Months Requested Salary ($)* Fringe Benefits* Funds Requested ($)* Post Doctoral Associates Graduate Students Undergraduate Students Secretarial/Clerical 0 Total Number Other Personnel Total Other Personnel 0.00 RESEARCH & RELATED Budget {A-B} (Funds Requested) Total Salary, Wages and Fringe Benefits (A+B) 24, Page 35

36 RESEARCH & RELATED BUDGET - SECTION C, D, & E, Budget Period 1 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 1 C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment Item Funds Requested ($)* Total funds requested for all equipment listed in the attached file Total Equipment 0.00 Additional Equipment: File Name: Mime Type: D. Travel Funds Requested ($)* 1. Domestic Travel Costs ( Incl. Canada, Mexico, and U.S. Possessions) 2. Foreign Travel Costs Total Travel Cost 0.00 E. Participant/Trainee Support Costs Funds Requested ($)* 1. Tuition/Fees/Health Insurance 2. Stipends 3. Travel 4. Subsistence 5. Other: Number of Participants/Trainees Total Participant Trainee Support Costs 0.00 RESEARCH & RELATED Budget {C-E} (Funds Requested) Page 36

37 RESEARCH & RELATED BUDGET - SECTIONS F-K, Budget Period 1 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 1 F. Other Direct Costs Funds Requested ($)* 1. Materials and Supplies 11, Publication Costs 3. Consultant Services 4. ADP/Computer Services 5. Subawards/Consortium/Contractual Costs 6. Equipment or Facility Rental/User Fees 7. Alterations and Renovations Total Other Direct Costs 11, G. Direct Costs Funds Requested ($)* Total Direct Costs (A thru F) 35, H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($)* 1. MTDC , , Total Indirect Costs 14, Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) HHS Office of Inspector General Office of Audit Services, Jeanette Lu (415) I. Total Direct and Indirect Costs Funds Requested ($)* Total Direct and Indirect Institutional Costs (G + H) 50, J. Fee Funds Requested ($)* K. Budget Justification* File Name: Subaward_Justification.pdf Mime Type: application/pdf RESEARCH & RELATED Budget {F-K} (Funds Requested) (Only attach one file.) Page 37

38 RESEARCH & RELATED BUDGET - SECTION A & B, Budget Period 2 OMB Number: Expiration Date: 06/30/2016 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Enter name of Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 2 A. Senior/Key Person # Prefix First Name* Middle Last Name* Suffix Project Role* Base Calendar Academic Summer Requested Fringe Funds Requested ($)* Name Salary ($) Months Months Months Salary ($)* Benefits ($)* 1. Jane Smith Co-Investigator 187, , , , Total Funds Requested for all Senior Key Persons in the attached file Additional Senior Key Persons: File Name: Total Senior/Key Person 24, Mime Type: B. Other Personnel Number of Personnel* Project Role* Calendar Months Academic Months Summer Months Requested Salary ($)* Fringe Benefits* Funds Requested ($)* Post Doctoral Associates Graduate Students Undergraduate Students Secretarial/Clerical 0 Total Number Other Personnel Total Other Personnel 0.00 RESEARCH & RELATED Budget {A-B} (Funds Requested) Total Salary, Wages and Fringe Benefits (A+B) 24, Page 38

39 RESEARCH & RELATED BUDGET - SECTION C, D, & E, Budget Period 2 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 2 C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment Item Funds Requested ($)* Total funds requested for all equipment listed in the attached file Total Equipment 0.00 Additional Equipment: File Name: Mime Type: D. Travel Funds Requested ($)* 1. Domestic Travel Costs ( Incl. Canada, Mexico, and U.S. Possessions) 2. Foreign Travel Costs Total Travel Cost 0.00 E. Participant/Trainee Support Costs Funds Requested ($)* 1. Tuition/Fees/Health Insurance 2. Stipends 3. Travel 4. Subsistence 5. Other: Number of Participants/Trainees Total Participant Trainee Support Costs 0.00 RESEARCH & RELATED Budget {C-E} (Funds Requested) Page 39

40 RESEARCH & RELATED BUDGET - SECTIONS F-K, Budget Period 2 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 2 F. Other Direct Costs Funds Requested ($)* 1. Materials and Supplies 11, Publication Costs 3. Consultant Services 4. ADP/Computer Services 5. Subawards/Consortium/Contractual Costs 6. Equipment or Facility Rental/User Fees 7. Alterations and Renovations Total Other Direct Costs 11, G. Direct Costs Funds Requested ($)* Total Direct Costs (A thru F) 35, H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($)* 1. MTDC , , Total Indirect Costs 14, Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) HHS Office of Inspector General Office of Audit Services, Jeanette Lu (415) I. Total Direct and Indirect Costs Funds Requested ($)* Total Direct and Indirect Institutional Costs (G + H) 50, J. Fee Funds Requested ($)* K. Budget Justification* File Name: Subaward_Justification.pdf Mime Type: application/pdf RESEARCH & RELATED Budget {F-K} (Funds Requested) (Only attach one file.) Page 40

41 RESEARCH & RELATED BUDGET - SECTION A & B, Budget Period 3 OMB Number: Expiration Date: 06/30/2016 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Enter name of Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 3 A. Senior/Key Person # Prefix First Name* Middle Last Name* Suffix Project Role* Base Calendar Academic Summer Requested Fringe Funds Requested ($)* Name Salary ($) Months Months Months Salary ($)* Benefits ($)* 1. Jane Smith Co-Investigator 187, , , , Total Funds Requested for all Senior Key Persons in the attached file Additional Senior Key Persons: File Name: Total Senior/Key Person 24, Mime Type: B. Other Personnel Number of Personnel* Project Role* Calendar Months Academic Months Summer Months Requested Salary ($)* Fringe Benefits* Funds Requested ($)* Post Doctoral Associates Graduate Students Undergraduate Students Secretarial/Clerical 0 Total Number Other Personnel Total Other Personnel 0.00 RESEARCH & RELATED Budget {A-B} (Funds Requested) Total Salary, Wages and Fringe Benefits (A+B) 24, Page 41

42 RESEARCH & RELATED BUDGET - SECTION C, D, & E, Budget Period 3 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 3 C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment Item Funds Requested ($)* Total funds requested for all equipment listed in the attached file Total Equipment 0.00 Additional Equipment: File Name: Mime Type: D. Travel Funds Requested ($)* 1. Domestic Travel Costs ( Incl. Canada, Mexico, and U.S. Possessions) 2. Foreign Travel Costs Total Travel Cost 0.00 E. Participant/Trainee Support Costs Funds Requested ($)* 1. Tuition/Fees/Health Insurance 2. Stipends 3. Travel 4. Subsistence 5. Other: Number of Participants/Trainees Total Participant Trainee Support Costs 0.00 RESEARCH & RELATED Budget {C-E} (Funds Requested) Page 42

43 RESEARCH & RELATED BUDGET - SECTIONS F-K, Budget Period 3 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 3 F. Other Direct Costs Funds Requested ($)* 1. Materials and Supplies 11, Publication Costs 3. Consultant Services 4. ADP/Computer Services 5. Subawards/Consortium/Contractual Costs 6. Equipment or Facility Rental/User Fees 7. Alterations and Renovations Total Other Direct Costs 11, G. Direct Costs Funds Requested ($)* Total Direct Costs (A thru F) 35, H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($)* 1. MTDC , , Total Indirect Costs 14, Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) HHS Office of Inspector General Office of Audit Services, Jeanette Lu (415) I. Total Direct and Indirect Costs Funds Requested ($)* Total Direct and Indirect Institutional Costs (G + H) 50, J. Fee Funds Requested ($)* K. Budget Justification* File Name: Subaward_Justification.pdf Mime Type: application/pdf RESEARCH & RELATED Budget {F-K} (Funds Requested) (Only attach one file.) Page 43

44 RESEARCH & RELATED BUDGET - SECTION A & B, Budget Period 4 OMB Number: Expiration Date: 06/30/2016 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Enter name of Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 4 A. Senior/Key Person # Prefix First Name* Middle Last Name* Suffix Project Role* Base Calendar Academic Summer Requested Fringe Funds Requested ($)* Name Salary ($) Months Months Months Salary ($)* Benefits ($)* 1. Jane Smith Co-Investigator 187, , , , Total Funds Requested for all Senior Key Persons in the attached file Additional Senior Key Persons: File Name: Total Senior/Key Person 24, Mime Type: B. Other Personnel Number of Personnel* Project Role* Calendar Months Academic Months Summer Months Requested Salary ($)* Fringe Benefits* Funds Requested ($)* Post Doctoral Associates Graduate Students Undergraduate Students Secretarial/Clerical 0 Total Number Other Personnel Total Other Personnel 0.00 RESEARCH & RELATED Budget {A-B} (Funds Requested) Total Salary, Wages and Fringe Benefits (A+B) 24, Page 44

45 RESEARCH & RELATED BUDGET - SECTION C, D, & E, Budget Period 4 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 4 C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment Item Funds Requested ($)* Total funds requested for all equipment listed in the attached file Total Equipment 0.00 Additional Equipment: File Name: Mime Type: D. Travel Funds Requested ($)* 1. Domestic Travel Costs ( Incl. Canada, Mexico, and U.S. Possessions) 2. Foreign Travel Costs Total Travel Cost 0.00 E. Participant/Trainee Support Costs Funds Requested ($)* 1. Tuition/Fees/Health Insurance 2. Stipends 3. Travel 4. Subsistence 5. Other: Number of Participants/Trainees Total Participant Trainee Support Costs 0.00 RESEARCH & RELATED Budget {C-E} (Funds Requested) Page 45

46 RESEARCH & RELATED BUDGET - SECTIONS F-K, Budget Period 4 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 4 F. Other Direct Costs Funds Requested ($)* 1. Materials and Supplies 11, Publication Costs 3. Consultant Services 4. ADP/Computer Services 5. Subawards/Consortium/Contractual Costs 6. Equipment or Facility Rental/User Fees 7. Alterations and Renovations Total Other Direct Costs 11, G. Direct Costs Funds Requested ($)* Total Direct Costs (A thru F) 35, H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($)* 1. MTDC , , Total Indirect Costs 14, Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) HHS Office of Inspector General Office of Audit Services, Jeanette Lu (415) I. Total Direct and Indirect Costs Funds Requested ($)* Total Direct and Indirect Institutional Costs (G + H) 50, J. Fee Funds Requested ($)* K. Budget Justification* File Name: Subaward_Justification.pdf Mime Type: application/pdf RESEARCH & RELATED Budget {F-K} (Funds Requested) (Only attach one file.) Page 46

47 RESEARCH & RELATED BUDGET - SECTION A & B, Budget Period 5 OMB Number: Expiration Date: 06/30/2016 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Enter name of Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 5 A. Senior/Key Person # Prefix First Name* Middle Last Name* Suffix Project Role* Base Calendar Academic Summer Requested Fringe Funds Requested ($)* Name Salary ($) Months Months Months Salary ($)* Benefits ($)* 1. Jane Smith Co-Investigator 187, , , , Total Funds Requested for all Senior Key Persons in the attached file Additional Senior Key Persons: File Name: Total Senior/Key Person 24, Mime Type: B. Other Personnel Number of Personnel* Project Role* Calendar Months Academic Months Summer Months Requested Salary ($)* Fringe Benefits* Funds Requested ($)* Post Doctoral Associates Graduate Students Undergraduate Students Secretarial/Clerical 0 Total Number Other Personnel Total Other Personnel 0.00 RESEARCH & RELATED Budget {A-B} (Funds Requested) Total Salary, Wages and Fringe Benefits (A+B) 24, Page 47

48 RESEARCH & RELATED BUDGET - SECTION C, D, & E, Budget Period 5 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 5 C. Equipment Description List items and dollar amount for each item exceeding $5,000 Equipment Item Funds Requested ($)* Total funds requested for all equipment listed in the attached file Total Equipment 0.00 Additional Equipment: File Name: Mime Type: D. Travel Funds Requested ($)* 1. Domestic Travel Costs ( Incl. Canada, Mexico, and U.S. Possessions) 2. Foreign Travel Costs Total Travel Cost 0.00 E. Participant/Trainee Support Costs Funds Requested ($)* 1. Tuition/Fees/Health Insurance 2. Stipends 3. Travel 4. Subsistence 5. Other: Number of Participants/Trainees Total Participant Trainee Support Costs 0.00 RESEARCH & RELATED Budget {C-E} (Funds Requested) Page 48

49 RESEARCH & RELATED BUDGET - SECTIONS F-K, Budget Period 5 ORGANIZATIONAL DUNS*: Budget Type*: Project Subaward/Consortium Organization: The Regents of the University of California, San Francisco Start Date*: End Date*: Budget Period: 5 F. Other Direct Costs Funds Requested ($)* 1. Materials and Supplies 11, Publication Costs 3. Consultant Services 4. ADP/Computer Services 5. Subawards/Consortium/Contractual Costs 6. Equipment or Facility Rental/User Fees 7. Alterations and Renovations Total Other Direct Costs 11, G. Direct Costs Funds Requested ($)* Total Direct Costs (A thru F) 35, H. Indirect Costs Indirect Cost Type Indirect Cost Rate (%) Indirect Cost Base ($) Funds Requested ($)* 1. MTDC , , Total Indirect Costs 14, Cognizant Federal Agency (Agency Name, POC Name, and POC Phone Number) HHS Office of Inspector General Office of Audit Services, Jeanette Lu (415) I. Total Direct and Indirect Costs Funds Requested ($)* Total Direct and Indirect Institutional Costs (G + H) 50, J. Fee Funds Requested ($)* K. Budget Justification* File Name: Subaward_Justification.pdf Mime Type: application/pdf RESEARCH & RELATED Budget {F-K} (Funds Requested) (Only attach one file.) Page 49

50 Subaward Justification NIH Resources: NIH SF424 R&R Develop Your Budget Budget Justification Attachment Page 50

51 RESEARCH & RELATED BUDGET - Cumulative Budget Totals ($) Section A, Senior/Key Person 122, Section B, Other Personnel 0.00 Total Number Other Personnel 0 Total Salary, Wages and Fringe Benefits (A+B) 122, Section C, Equipment 0.00 Section D, Travel Domestic Foreign 0.00 Section E, Participant/Trainee Support Costs 1. Tuition/Fees/Health Insurance Stipends Travel Subsistence Other Number of Participants/Trainees 0 Section F, Other Direct Costs 56, Materials and Supplies 56, Publication Costs Consultant Services ADP/Computer Services Subawards/Consortium/Contractual Costs 6. Equipment or Facility Rental/User Fees Alterations and Renovations Other Other Other Section G, Direct Costs (A thru F) , Section H, Indirect Costs 71, Section I, Total Direct and Indirect Costs (G + H) 250, Section J, Fee 0.00 Page 51

52 Total Direct Costs less Consortium F&A NIH policy (NOT-OD ) allows applicants to exclude consortium/contractual F&A costs when determining if an application falls at or beneath any applicable direct cost limit. When a direct cost limit is specified in an FOA, the following table can be used to determine if your application falls within that limit. Category Budget Period 1 Budget Period 2 Budget Period 3 Budget Period 4 Budget Period 5 TOTALS Total Direct Costs less Consortium F&A 484, , , , ,337 2,421,685 Page 52 Funding Opportunity Number: PA Received Date:

53 PHS 398 Cover Page Supplement OMB Number: Expiration Date: 10/31/ Human Subjects Section Clinical Trial? Yes No *Agency-Defined Phase III Clinical Trial? Yes No 2. Vertebrate Animals Section Are vertebrate animals euthanized? Yes No If "Yes" to euthanasia Is the method consistent with American Veterinary Medical Association (AVMA) guidelines? Yes No If "No" to AVMA guidelines, describe method and proved scientific justification 3. *Program Income Section *Is program income anticipated during the periods for which the grant support is requested? Yes No If you checked "yes" above (indicating that program income is anticipated), then use the format below to reflect the amount and source(s). Otherwise, leave this section blank. *Budget Period *Anticipated Amount ($) *Source(s) Page 53

54 PHS 398 Cover Page Supplement 4. Human Embryonic Stem Cells Section *Does the proposed project involve human embryonic stem cells? Yes No If the proposed project involves human embryonic stem cells, list below the registration number of the specific cell line(s) from the following list: Or, if a specific stem cell line cannot be referenced at this time, please check the box indicating that one from the registry will be used: Cell Line(s) (Example: 0004): Specific stem cell line cannot be referenced at this time. One from the registry will be used. 5. Inventions and Patents Section (RENEWAL) *Inventions and Patents: Yes No If the answer is "Yes" then please answer the following: *Previously Reported: Yes No 6. Change of Investigator / Change of Institution Section Change of Project Director / Principal Investigator Name of former Project Director / Principal Investigator Prefix: *First Name: Middle Name: *Last Name: Suffix: Change of Grantee Institution *Name of former institution: Page 54

55 PHS 398 Research Plan OMB Number: Expiration Date: 10/31/2018 Introduction 1. Introduction to Application (Resubmission and Revision) Research Plan Section 2. Specific Aims Specific_Aims.pdf 3. Research Strategy* Research_Strategy.pdf 4. Progress Report Publication List Human Subjects Section 5. Protection of Human Subjects Protection_of_Human_Subjects.pdf 6. Data Safety Monitoring Plan 7. Inclusion of Women and Minorities Inclusion_of_Women_and_Minorities.pdf 8. Inclusion of Children Inclusion_of_Children.pdf Other Research Plan Section 9. Vertebrate Animals Vertebrate_Animals.pdf 10. Select Agent Research Select_Agent_Research.pdf 11. Multiple PD/PI Leadership Plan 12. Consortium/Contractual Arrangements Consortium-Contractual_Arrangements.pdf 13. Letters of Support Letters_of_Support.pdf 14. Resource Sharing Plan(s) Resource_Sharing_Plan.pdf 15. Authentication of Key Biological and/or Chemical Resources Authentication_of_Key_Biological_Chemical_Resources.pdf Appendix 16. Appendix Appendix.pdf Page 55 Funding Opportunity Number: PA Received Date:

56 2. Specific Aims PI/Department is responsible for this document. Instructions for Specific Aims Instructions to Format Attachments Page Limit Guide Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Specific Aims Page 56

57 3. Research Strategy PI/Department is responsible for this document. Instructions for Research Strategy Instructions to Format Attachments Page Limit Guide Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Research Strategy Page 57

58 5. Protection of Human Subjects Instructions for Protection of Human Subjects PI/Department is responsible for this document. Who must complete the "Protection of Human Subjects" attachment: Include a "Protection of Human Subjects" attachment if you answered "Yes" to the question "Are human subjects involved?" on G R&R Other Project Information Form. Note: If you answered "No" to the "Are human subjects involved" question but your proposed research involves human specimens and/or data from subjects, you must provide a justification in this attachment for your claim that no human subjects are involved. Instructions to Format Attachments Tip: In addition to using... General Application Guide for NIH and Other PHS Agencies / SF424 (R&R)... Be sure to read your specific Program Announcement for additional instructions. Protection of Human Subjects Page 58