Attachment No. 7 Propos SummaryNIH-204.pdf
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- Attached to
- Pharmacology and Toxicology for Therapeutics Program (PTTP) Federal contract opportunity
- Solicitation number
- NIH-NINDS-75N95021R00017
About this file
This document appears to be an attachment to a proposal submission for a National Institutes of Health contract opportunity. The attachment requests key details about the proposing organization and principal investigators, including legal names, addresses, estimated project costs and timelines, subcontracting information if applicable, human subjects protocols, and acknowledgement of any solicitation amendments. Signatures are also required from the principal investigator and business representative to authorize contract negotiations and execution. Social security numbers may be provided voluntarily for identification and program management purposes.
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Text version
ATTACHMENT No. 7
NIH-2043
June 1982
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PUBLIC HEALTH SERVICE
NATIONAL INSTITUTES OF HEALTH
PROPOSAL SUMMARY AND DATA RECORD
RFP/CONTRACT NUMBER
PROJECT TITLE (Title or 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
ESTIMATED DIRECT COSTS IN PROPOSED YEAR (From Budget
PROPOSED STARTING DATE
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.)
NAME AND TITLE OF PRINCIPAL INVESTIGATOR
SOCIAL SECURITY
NO.
EST. HOURS
WEEKLY
AREA
CODE/TEL.NO.
NAME AND TITLE OF CO-INVESTIGATOR (Use attachment if necessary.)
NAME AND TITLE OF INDIVIDUAL(S) AUTHORIZED TO
NEGOTIATE CONTRACTS
AREA CODE/TELEPHONE NUMBER
NAME AND TITLE OF INDIVIDUAL(S) AUTHORIZED TO EXECUTE
CONTRACTS
AREA CODE/TELEPHONE NUMBER
DOES THIS PROPOSAL INVOLVE EXPERIMENTS WITH HUMAN SUBJECTS YES NO
Institution’s General Assurance re: Human Subjects DATE APPROVED PENDING
Institution’s Review Board’s Approval of this Proposal DATE APPROVED PENDING An example of the informed consent for this study is enclosed YES NO
A Clinical Protocol is enclosed YES NO OFFEROR’S ACKNOWLEDGMENT 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
ATTACHMENT No. 7
NIH-2043
June 1982
Provision of the Social Security Number is voluntary. Social
Security Numbers are requested for the purpose of accurate and efficient identification, review, and management of NIH
Extramural Programs. Authority for requesting this information is provided by Title III, Section 301, and Title IV of the Public Health Service Act, as amended.
File details come from the government source that posted it. Updated .