N01PC65003-74_Amendment_2_SF_30_final.pdf

Planned Enrollment Report

This report format should NOT be used for collecting data from study participants.

Study Title:

Domestic/Foreign: Domestic

Comments:

Ethnic Categories

Racial Categories Not Hispanic or Latino Hispanic or Latino Total

Female Male Female Male

American Indian/ Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

Black or African American

White

More Than One Race

Total

PHS 398 / PHS 2590 (Rev. 08/12 Approved Through 8/31/2015) OMB No. 0925-0001/0002 Page Planned Enrollment Report oliverlj Typewritten Text oliverlj Typewritten Text oliverlj Typewritten Text Attachment 10: Planned Enrollment Report Page 1 of 1

RFP: N01PC65003-74

SUMMARY OF RELATED ACTIVITIES

The following specific information must be provided by the offeror pertaining to the Project Director, Principal Investigator, and each of any other proposed key professional individuals designated for performance under any resulting contract.

a. Identify the total amount of all presently active federal contracts/cooperative agreements/grants and commercial agreements citing the committed levels of effort for those projects for each of the key individuals* in this proposal.

Professional's Name and Title/Position:

Identifying Number Agency Total Effort Committed

*If an individual has no obligation(s), so state.

b. Provide the total number of outstanding proposals, exclusive of the instant proposal, having been submitted by your organization, not presently accepted but in an anticipatory stage, which will commit levels of effort by the proposed professional individuals*.

Professional's Name and Title/Position:

Identifying Number Agency Total Effort Committed

*If no commitment of effort is intended, so state.

c. Provide a statement of the level of effort to be dedicated to any resultant contract awarded to your organization for those individuals designated and cited in this proposal.

Name Title/Position Total Proposed Effort

Summary of Related Activities

(1/2011)

Attachment 12: Summary of Related Activities

RFP: N01PC65003-74