Research And Related Other Project Information [V1.4].pdf
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- Attached to
- FY21 DEFENSE ESTABLISHED PROGRAM TO STIMULATE COMPETITIVE RESEARCH (DEPSCoR) - RESEARCH COLLABORATION (RC)
- Opportunity number
- FOA-AFRL-AFOSR-2021-0007
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Research And Related Other Project Information [V1.4]
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RR_OtherProjectInfo mhughes D:20061211095927- 05'00' D:20061211095927- 05'00'
1. Are Human Subjects Involved?
IRB Approval Date:
Human Subject Assurance Number:
2. Are Vertebrate Animals Used?
IACUC Approval Date:
Animal Welfare Assurance Number:
4.b. If yes, please explain:
4.c. If this project has an actual or potential impact on the environment, has an exemption been authorized or an environmental assessment (EA) or environmental impact statement (EIS) been performed?
4.d. If yes, please explain:
6. Does this project involve activities outside of the United States or partnerships with international collaborators?
6.b. Optional Explanation:
7. Project Summary/Abstract
11. Equipment
8. Project Narrative
12. Other Attachments RESEARCH & RELATED Other Project Information Is the IACUC review Pending?
If no, is the IRB review Pending?
2.a.
If YES to Vertebrate Animals
3. Is proprietary/privileged information included in the application?
4.a. Does this Project Have an Actual or Potential Impact - positive or negative - on the environment?
6.a. If yes, identify countries:
9. Bibliography & References Cited
10. Facilities & Other Resources Are Human Subjects Involved is required.
Are Human Subject Involved: If activities involving human subjects are planned at any time during the proposed project at any performance site. Check yes even if the proposed project is exempt from Regulations for the Protection of Human Subjects. If no, skip the rest of block 1.
This field is required.
1.a.
If YES to Human Subjects Is the Project Exempt from Federal regulations is required.
Is the Project Exempt from Federal regulations?
Is the IRB review Pending is required.
Is the IRB review Pending?
If yes, check appropriate exemption number.
Are Vertebrate Animals Used is required.
Are Vertebrate Animals Used? If activities involving vertebrate animals are planned at any time during the proposed project at any performance site, check yes. If no, skip the rest of block 2.
Is the IACUC review Pending is required.
Is the IACUC review Pending? Indicate if an Institutional Animal Care and Use Committee (IACUC) review is pending.
Is proprietary/privileged information included in the application is required.
Is proprietary/privileged information included in the application: Patentable ideas, trade secrets, privileged or confidential commercial or financial information, disclosure of which may harm the applicant, should be included in applications only when such information is necessary to convey an understanding of the proposed project. If the application includes such information, check yes and clearly mark each line or paragraph on the pages containing the proprietary/privileged information with a legend similar to: "The following contains proprietary/privileged information that (name of applicant) requests not be released to persons outside the Government, except for purposes of review and evaluation." This field is required.
Does this project have an actual or potential impact - positive or negative - on the environment is required.
Does this project have an actual or potential impact on the environment: Indicate if this project has an actual or potential impact on the environment? This field is required.
Does this project involve activities outside of the United States or partnerships with international collaborators is required.
Does this project involve activities outside of the United States or partnerships with international collaborators? Indicate whether this project involve activities outside of the United States or partnerships with international collaborators. This field is required.
Form Attachments:
Is the Project Exempt from Federal regulations?
5. Is the research performance site designated, or eligible to be designated, as a historic place?
Is the research performance site designated, or eligible to be designated, as a historic place is required.
Is the research performance site designated, or eligible to be designated, as a historic place?: If any research performance site is designated or eligible to be designated as a historic place, if Yes, check the Yes box and then provide an explanation in the box provided in 5.a. Otherwise, check the No box.
5.a. If yes, please explain:
OMB Number: 4040-0001 Expiration Date: 12/31/2022
| Optional Explanation: Enter an explanation for involvement with outside entities (optional).: |
| Mandatory: |
| Is proprietary/privileged information included in the application? - Yes: |
Patentable ideas, trade secrets, privileged or confidential commercial or financial information, disclosure of which may harm the applicant, should be included in applications only when such information is necessary to convey an understanding of the proposed project. If the application includes such information, check yes and clearly mark each line or paragraph on the pages containing the proprietary/privileged information with a legend similar to: "The following contains proprietary/privileged information that (name of applicant) requests not be released to persons outside the Government, except for purposes of review and evaluation." This field is required.:
Is proprietary/privileged information included in the application? - No:
Patentable ideas, trade secrets, privileged or confidential commercial or financial information, disclosure of which may harm the applicant, should be included in applications only when such information is necessary to convey an understanding of the proposed project. If the application includes such information, check yes and clearly mark each line or paragraph on the pages containing the proprietary/privileged information with a legend similar to: "The following contains proprietary/privileged information that (name of applicant) requests not be released to persons outside the Government, except for purposes of review and evaluation." This field is required.:
| T240: |
| Exemption Number 1: If human subject activities are exempt from Federal regulations, provide the exemption numbers corresponding to one or more of the exemption categories. The eight categories of research that qualify for exemption from coverage by the regulations are defined in the Common Rule for the Protection of Human Subjects.: |
| Exemption Number 2: If human subject activities are exempt from Federal regulations, provide the exemption numbers corresponding to one or more of the exemption categories. The eight categories of research that qualify for exemption from coverage by the regulations are defined in the Common Rule for the Protection of Human Subjects.: |
| Exemption Number 3: If human subject activities are exempt from Federal regulations, provide the exemption numbers corresponding to one or more of the exemption categories. The eight categories of research that qualify for exemption from coverage by the regulations are defined in the Common Rule for the Protection of Human Subjects.: |
| Exemption Number 4: If human subject activities are exempt from Federal regulations, provide the exemption numbers corresponding to one or more of the exemption categories. The eight categories of research that qualify for exemption from coverage by the regulations are defined in the Common Rule for the Protection of Human Subjects.: |
| Exemption Number 5: If human subject activities are exempt from Federal regulations, provide the exemption numbers corresponding to one or more of the exemption categories. The eight categories of research that qualify for exemption from coverage by the regulations are defined in the Common Rule for the Protection of Human Subjects.: |
| Exemption Number 6: If human subject activities are exempt from Federal regulations, provide the exemption numbers corresponding to one or more of the exemption categories. The eight categories of research that qualify for exemption from coverage by the regulations are defined in the Common Rule for the Protection of Human Subjects.: |
| Exemption Number 7: If human subject activities are exempt from Federal regulations, provide the exemption numbers corresponding to one or more of the exemption categories. The eight categories of research that qualify for exemption from coverage by the regulations are defined in the Common Rule for the Protection of Human Subjects.: |
| Exemption Number 8: If human subject activities are exempt from Federal regulations, provide the exemption numbers corresponding to one or more of the exemption categories. The eight categories of research that qualify for exemption from coverage by the regulations are defined in the Common Rule for the Protection of Human Subjects.: |
| ExemptionNumber: |
| IRB Approval Date: Enter the latest Institutional Review Board (IRB) approval date (if available). Leave blank if Pending.: |
| Human Subject Assurance Number: Enter the approved Federal Wide Assurance (FWA), Multiple Project Assurance (MPA), Single Project Assurance (SPA) Number or Cooperative Project Assurance Number that the applicant has on file with the Office for Human Research Protections, if available. If the applicant has a FWA number, enter the 8-digit number. Do not enter the FWA before the number.: |
| IACUC Approval Date: Enter the latest Institutional Review Board (IRB) approval date (if available). Leave blank if Pending.: |
| Animal Welfare Assurance Number: Enter the Federally approved assurance number, if available.: |
| Is the research performance site designated, or eligible to be designated, as a historic place? - No: If any research performance site is designated or eligible to be designated as a historic place, if Yes, check the Yes box and then provide an explanation in the box provided in 5.a. Otherwise, check the No box. This field is required.: |
| If yes, please explain: Enter explanation of the actual or potential impact on the environment.: |
| If this project has an actual or potential impact on the environment, has an exemption been authorized or an Environmental Assessment (EA) or an Environmental Impact Statement (EIS) been performed? - Yes: Check yes or no.: |
| If this project has an actual or potential impact on the environment, has an exemption been authorized or an Environmental Assessment (EA) or an Environmental Impact Statement (EIS) been performed? - No: Check yes or no.: |
| If yes, please explain: Enter additional details about the EA or EIS.: |
| If yes, identify countries: Enter the countries with which international cooperative activities are involved.: |
| SubmissionTypeCode: |
| Project Summary/Abstract - View Attachment: |
| Project Summary/Abstract - Delete Attachment: |
| Project Summary/Abstract: The Project Summary must contain a summary of the proposed activity suitable for dissemination to the public. It should be a self-contained description of the project and should contain a statement of objectives and methods to be employed. It should be informative to other persons working in the same or related fields and insofar as possible understandable to a scientifically or technically literate lay reader. This Summary must not include any proprietary/confidential information.: |
| Project Summary/Abstract - Add Attachment: The Project Summary must contain a summary of the proposed activity suitable for dissemination to the public. It should be a self-contained description of the project and should contain a statement of objectives and methods to be employed. It should be informative to other persons working in the same or related fields and insofar as possible understandable to a scientifically or technically literate lay reader. This Summary must not include any proprietary/confidential information.: |
| Project Narrative - View Attachment: |
| Project Narrative - Delete Attachment: |
| Project Narrative - Add Attachment: Provide Project Narrative in accordance with the announcement and/or agency-specific instructions.: |
| Project Narrative: Provide Project Narrative in accordance with the announcement and/or agency-specific instructions.: |
| Bibliography/References Cited - View Attachment: |
| Bibliography/References Cited - Delete Attachment: |
| Bibliography/References Cited - Add Attachment: Provide a bibliography of any references cited in the Project Narrative. Each reference must include the names of all authors (in the same sequence in which they appear in the publication), the article and journal title, book title, volume number, page numbers, and year of publication. Include only bibliographic citations. Applicants should be especially careful to follow scholarly practices in providing citations for source materials relied upon when preparing any section of the application.: |
| Bibliography/References Cited: Provide a bibliography of any references cited in the Project Narrative. Each reference must include the names of all authors (in the same sequence in which they appear in the publication), the article and journal title, book title, volume number, page numbers, and year of publication. Include only bibliographic citations. Applicants should be especially careful to follow scholarly practices in providing citations for source materials relied upon when preparing any section of the application. To attach a document for Bibliography and References Cited, click “Add Attachment”.: |
| Facilities & Other Resources - View Attachment: |
| Facilities & Other Resources - Delete Attachment: |
| Facilities & Other Resources - Add Attachment: This information is used to assess the capability of the organizational resources available to perform the effort proposed. Identify the facilities to be used (Laboratory, Animal, Computer, Office, Clinical and Other). If appropriate, indicate their capacities, pertinent capabilities, relative proximity and extent of availability to the project. Describe only those resources that are directly applicable to the proposed work. Provide any information describing the Other Resources available to the project (e.g., machine shop, electronic shop) and the extent to which they would be available to the project.: |
| Facilities & Other Resources: This information is used to assess the capability of the organizational resources available to perform the effort proposed. Identify the facilities to be used (Laboratory, Animal, Computer, Office, Clinical and Other). If appropriate, indicate their capacities, pertinent capabilities, relative proximity and extent of availability to the project. Describe only those resources that are directly applicable to the proposed work. Provide any information describing the Other Resources available to the project (e.g., machine shop, electronic shop) and the extent to which they would be available to the project.: |
| Equipment - View Attachment: |
| Equipment - Delete Attachment: |
| Equipment - Add Attachment: List major items of equipment already available for this project and, if appropriate identify location and pertinent capabilities.: |
| Equipment: List major items of equipment already available for this project and, if appropriate identify location and pertinent capabilities.: |
| FileName: |
| MimeType: |
| href: |
| hashAlgorithm: |
| HashValue_data: |
| Other Attachments - View Attachments: |
| Other Attachments - Delete Attachments: |
| Other Attachments - Add Attachments: Attach a file to provide any other project information not provided above or in accordance with the announcement and/or agency-specific instruction. : |
| FNList: |
| ObjList: |
| AttCount: |
| Add: |
| Delete: |
| View: |
| Done: |
| goNext: |
| Optional Other Attachment Check Box. Indicates whether an Optional Other Attachment is attached.: |
| If yes, please explain: If you checked the Yes box indicating any performance site is designated, or eligible to be designated, as a historic place, provide the explanation here.: |
| XDPFirstField: |
| LastField: |
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