Att_9_Proposal_Summary_and_Data_Record__NIH-2043.pdf
PDF 87 KB Posted
- Attached to
- RADx Award Management
- Solicitation number
- 75N92026Q00012
About this file
This is the NIH Proposal Summary and Data Record form (NIH-2043), a template used by the Department of Health and Human Services National Institutes of Health to collect standardized information from organizations submitting proposals in response to RFPs or contract opportunities.
The form captures essential proposal details including the offeror's legal name and address, place of performance, contract type (cost-reimbursement, fixed price, cost-plus fixed-fee, or other), estimated project completion time, proposed start date, and estimated direct costs. It requires identification of the principal investigator and any co-investigators with their estimated weekly hours and contact information, as well as individuals authorized to negotiate and execute contracts. The form includes fields for the offeror's Employer Identification Number, current employee count, and annual dollar volume of business, along with the cognizant government audit agency information. Proposals must include acknowledgment of any RFP amendments or errata and specify offer expiration (defaulting to 120 days if unspecified). The form also requires disclosure of subcontractor involvement if applicable. Additionally, the form addresses regulatory compliance by requesting information on human subjects research with IRB approval status and assurance numbers, vertebrate animal use with IACUC review status and animal welfare assurance numbers, inclusion of informed consent examples, and clinical protocols where applicable. Signatures from both the principal investigator and business representative are required, along with the offer date.
View the file
Other files
Show all 20
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
PROPOSAL SUMMARY AND DATA RECORD
RFP NUMBER/CONTRACT NUMBER
PROJECT TITLE (Title of RFP or Contract Proposal)
LEGAL NAME AND ADDRESS OF OFFEROR PLACE OF PERFORMANCE (Full address including ZIP)
TYPE OF CONTRACT PROPOSED
COST-REIMBURSEMENT FIXED PRICE COST-PLUS FIXED-FEE OTHER
ESTIMATED TIME REQUIRED TO COMPLETE PROJECT PROPOSED STARTING DATE
ESTIMATED DIRECT COSTS IN PROPOSED YEAR (From Budget)
DOES THIS PROPOSAL INCLUDE A SUBCONTRACT? YES NO
(If yes, please furnish name and location of organization, description of services, basis for selection, responsible person employed by subcontractor and cost information.) (Use attachment if necessary.)
NAME AND TITLE OF PRINCIPAL INVESTIGATOR EST. HOURS WEEKLY AREA CODE/TEL. NO.
NAME AND TITLE OF CO-INVESTIGATOR (Use attachment if necessary) EST. HOURS WEEKLY AREA CODE/TEL. NO.
NAME AND TITLE OF INDIVIDUAL(S) AUTHORIZED TO NEGOTIATE CONTRACTS
NAME AND TITLE OF INDIVIDUAL(S) AUTHORIZED TO EXECUTE CONTRACTS
DOES THIS PROPOSAL INVOLVE HUMAN
SUBJECTS RESEARCH? YES NO EXEMPTION NUMBER (IFAPPLICABLE)
If YES to Human Subjects, is the IRB review Pending? YES NO If IRB Review Not Pending, IRB Approval Date
Human Subjects Assurance Number
An example of the informed consent for this study is enclosed YES NO N/A A Clinical Protocol is enclosed YES NO N/A
Are Vertebrate Animals Used? YES NO
If YES to Vertebrate Animals, is the IACUC review Pending? YES NO
If IACUC Review Not Pending, IRB Approval Date Animal Welfare Assurance Number
OFFEROR’S ACKNOWLEDGEMENT OF AMENDMENTS TO THE RFP (use attachment if necessary)
ERRATA
NUMBER
DATE ERRATA
NUMBER
DATE
NAME, ADDRESS, AND PHONE NUMBER OF COGNIZANT
GOVERNMENT AUDIT AGENCY
NUMBER OF EMPLOYEES CURRENTLY EMPLOYED
DOLLAR VOLUME OF BUSINESS PER ANNUM
THIS OFFER EXPIRES DAYS FROM THE DATE OF THIS OFFER.
(120 DAYS IF NOT SPECIFIED)
FOR THE INSTITUTION
SIGNATURE OF PRINCIPAL INVESTIGATOR SIGNATURE OF BUSINESS REPRESENTATIVE
TYPED NAME AND TITLE TYPED NAME AND TITLE
EMPLOYER IDENTIFICATION NUMBER DATE OF OFFER
NIH-2043 (Rev. 07/08)
File details come from the government source that posted it. Updated .