Attachment_D_PROPOSAL_TEMPLATE_VOLUME_2_-_ADMINISTRATIVE___NATIONAL_POLICY_REQUIREMENTS.docx

DARPARA2501 Young Faculty Award (YFA)

Attachment D

Volume 2: Administrative and National Policy Requirements Template

Use of this template is mandatory. Failure to use this template or follow the instructions herein may result in the submission being determined non-conforming. Additional information regarding a non-conforming determination may be found in Section III of the RA.

The Administrative and National Policy Requirements document must be completed in full and included as part of the proposal submission. Do not delete any portion of this document.

All pages shall be formatted for printing on 8-1/2 by 11-inch paper with 1-inch margins and font size not smaller than 11 point. Font sizes of 8 or 10 point may be used for figures, tables, and charts. Instructional text (identified in brackets) may be deleted.

The Administrative and National Policy Requirements document must be in .pdf, .odx, .doc, or .docx formats. Submissions must be written in English.

No page limit has been specified for the Administrative and National Policy Requirements document.

Source Selection Information – Competition Sensitive – Government Use Only

DARPA-BAA-16-22 1

[PRIME ORGANIZATION LOGO (Optional)]

Cover Sheet

Volume 2: Administrative and National Policy Requirements

DARPARA2501

DARPA Technical Office

Thrust Area

Keyword

Proposal Title

Proposer Organization

Address:

Telephone:

Email:

Address:

Telephone:

Email:

Date Proposal was Prepared

Proposal Validity Period (minimum 120 days)

Table of Contents

DARPARA2501 Volume 2 6 Team Member Identification [Provide a list of all team members including the prime, subawardee(s), and consultant(s), as applicable.]

Prime

Subawardees/Consultants

Organizational Conflict of Interest Affirmations and Disclosure [In accordance with Section III of the RA, provide the following information.]

a. Are any of the proposed individual team members or their respective organizations (whether prime or subawardee or consultant) currently providing SETA, A&AS or similar support to DARPA? No Yes

b. Did any of the proposed individual team members or their respective organizations (whether prime or subawardee or consultant) provide SETA, A&AS or similar support to DARPA within one calendar year of this proposal submission? No Yes

[If you answered “Yes” to a or b above, provide the following information for each applicable team member:

· The name of the DARPA office receiving the support;

· The prime contract number;

· Identification of proposed team member (subawardee, consultant) providing the support; and

· An OCI mitigation plan in accordance with §200.112 and §200.318, .]

c. Are there any other potential Organizational Conflicts of Interest involving any of the proposed individual team members or their respective organizations (whether prime or subawardee or consultant)? No Yes [If yes, provide the following information for each applicable team member:

· Identification of applicable team member; and

· An OCI mitigation plan in accordance with §200.112 and §200.318,.]

Intellectual Property (IP) [Provide the following information, as applicable. Note: the Government will assume unlimited rights to all IP not explicitly identified as restricted in the proposal.]

a. Technical Data and Computer Software Are you asserting any IP restrictions on any technical data or computer software that will be delivered to the Government?

No Yes [If yes, list all proprietary claims to results, prototypes, deliverables or systems supporting and/or necessary for the use of the proposed research, results, prototypes and/or deliverables. Provide a short summary for each item asserted with less than unlimited rights that describes the nature of the restriction and the intended use of the intellectual property in the conduct of the proposed research. Use the following format for these lists.]

NONCOMMERCIAL

Asserted Rights Category

Name of Person Asserting Restrictions

COMMERCIAL

Asserted Rights Category

Name of Person Asserting Restrictions

b. Patents Does the proposed effort involve using patented inventions that are owned by or assigned to the proposing organization or individual? No Yes [If yes, provide documentation proving ownership or possession of appropriate licensing rights to all patented inventions to be used for the proposed project. If a patent application has been filed for an invention, but it includes proprietary information and is not publicly available, provide documentation that includes: the patent number, inventor name(s), assignee names (if any), filing date, filing date of any related provisional application, and summary of the patent title, with either: (1) a representation of invention ownership; or (2) proof of possession of appropriate licensing rights in the invention (i.e., an agreement from the owner of the patent granting license to the proposer).]

Human Subjects Research (HSR) Does the proposed work involve HSR? No Yes [If yes, provide evidence of or a plan for review by an institutional review board (IRB)].

Animal Use Does the proposed work involve animal use? No Yes [If yes, provide a brief description of the plan for Institutional Animal Care and Use Committee (IACUC) review and approval.]

Representations Regarding Unpaid Delinquent Tax Liability or a Felony Conviction under Any Federal Law [Complete the following statements.] The Proposer represents that –

(i) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability,

(ii) It is [ ] is not [ ] a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.