Attachment 14 - Proposal Summary and Data Record (NIH-2043).pdf
PDF 87 KB Posted
- Attached to
- In Vitro Assessments of Antimicrobial Activity
- Solicitation number
- 75N93024R00024
About this file
This is NIH Form 2043, a Proposal Summary and Data Record form that contractors must complete when submitting proposals to the National Institutes of Health. The form captures key information about the proposal including the offeror's legal name and address, place of performance, type of contract (cost-reimbursement, fixed price, cost-plus fixed-fee, or other), estimated completion time, proposed start date, estimated direct costs, subcontract details, and key personnel information.
The form also includes sections for human subjects research approvals, vertebrate animal use authorizations, IRB/IACUC review status, acknowledgement of RFP amendments, audit agency information, and signature blocks for both the Principal Investigator and business representative. This appears to be a standard template form (revision date 07/08) that would need to be filled out by contractors responding to NIH solicitations.
View the file
Other files
Show all 21
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 .