Forms

Form Name:

Request for Extramural Support

Form Use:

The RES form is used to provide essential information about each individual proposed project, all required approvals and signatures, and any commitments of UCSD resources.

Please Note: A new RES form is required each time a New, Continuation, Renewal, or Supplement proposal is submitted to a funding agency or basically when new or additional funding is anticipated. However, a new RES form will not be required for eSNAPS submitted by the PI or for Revisions or revised Budgets to current proposals that have not yet been funded.

Form Submitted:

The RES form must be submitted to the appropriate UCSD Proposal Review Office with each proposal.

Form Access:

The RES form has been created in 2 formats. Please select the format below that is appropriate for your situation.

RES Form - 1 Page Format:

Space available for one Principal Investigator and one Co-Principal Investigator.

• PDF
• Excel
• RES Form Instructions

RES Form - 2 Page Format:

Space available for one Principal Investigator and up to three additional Co-Principal Investigators.

• PDF
• Excel
• RES Form Instructions

Form Name:

UCSD Proposal Budget Form

Form Use:

The UCSD Proposal Budget Form is used when there is no specific agency budget form.

Form Submitted:

Please submit the UCSD Proposal Budget Form to:  

• OCGA for General Campus and Health Sciences.
• SIO Contract and Grant Office for SIO.

Form Access:

• Excel
• Budget Form Instructions

Form Tools:

• Budget Preparation Components

• Indirect Cost Estimator for a period of performance of 12 months, created as an Excel file, will assist you in estimating your budget for periods of performance that are 12 months in length. By filling in the "Red" numbers, the "Blue" numbers will be automatically calculated according to the pre-programmed formulas. To access this useful tool, click here.

• Indirect Cost Estimator for a period of performance "other" than 12 months, created as an Excel file, will assist you in estimating your budget for periods of performance other than 12 months. By filling in the "Red" numbers, the "Blue" numbers will be automatically calculated according to the pre-programmed formulas. To access this useful tool, click here.

Form Name:

UCSD Proposal Signature Page - also referred to as Face Page or Cover Page.

Form Use:

The UCSD Proposal Signature Page is used when there is no specific agency signature page.

Form Submitted:

Please submit the UCSD Proposal Signature Page to OCGA as part of the proposal package.  

Form Access:

The UCSD Proposal Signature Page has been created in 2 formats. Please select the format below that is appropriate for your situation.

Signature Page - 1 Page Format:

Space available for one Principal Investigator and one Co-Principal Investigator.

• PDF
• Excel
• Signature Page Instructions

Signature Page - 2 Page Format:

Space available for one Principal Investigator and up to six additional Co-Principal Investigators.

• PDF
• Excel
• Signature Page Instructions

Form Name:

Request for Exception to Submit Proposal for Extramural Support

Form Use:

The PI Exception form is used when a proposal is being submitted by an individual (usually an academic) whose title is not automatically eligible. For a complete description of eligibility criteria - PPM 150-10, click here.

For a Summary of Eligibility, click here.

Questions regarding qualifications of Principal Investigators should be referred to the offices of the Vice Chancellor for Research (for General Campus), Dean-School of Medicine (for Health Sciences), or Vice Chancellor-Marine Sciences (for SIO), as appropriate.

Form Submitted:

The PI Exception form is to be submitted 10 business days prior to the agency due date for proposal submittal. Please submit the paperwork to:  

• Research Affairs for General Campus.
• HSSPPO for Health Sciences.
• SIO Academic Personnel for SIO.

Form Access:

• PDF
• Excel

Form Name:

National Institutes of Health Assurance Statement for Principal Investigators

Form Use:

The PI Assurance form is required for all Principal Investigators submitting New and Renewal proposals to the National Institutes of Health or NIH.

Form Submitted:

The PI Assurance form must be submitted to the appropriate UCSD Proposal Review Office with each New and Renewal NIH proposal.

Form Access:

• PDF
• Excel

Form Name:

National Institutes of Health Ruth L. Kirschstein Assurance Statement for an Individual Fellowship

Form Use:

The Fellowship Assurance form is required for all Pre-doctoral and all Post-doctoral Fellows submitting proposals for Ruth L. Kirschenstein Individual Fellowships.

Form Submitted:

The Fellowship Assurance form must be submitted, as applicable with each proposal to either; OCGA, SIO, Rachel Cook in the Health Sciences Dean's Office, or OGS.

Form Access:

• PDF
• Excel

Form Name:

Request for Advance Approval to Establish Accounts and Incur Expenses

Form Use:

The Advance Approval form is used to officially begin to incur expenses on a project in advance of the award document being received by the University. Costs requested should be limited to no more than two months, an alternate fund number is required to potentially absorb the expenses, and all compliance issues must be resolved/approved (i.e., Human Subjects, Animal Subjects, Conflict of Interest).

Form Submitted:

Please submit the Request for Advance Approval to Establish Accounts and Incur Expenses to:

• OCGA for General Campus and Health Sciences.
• SIO Contract and Grant Office for SIO.

Form Access:

• PDF    
• Excel
• Advance Approval Form Instructions

Form Name:

Federal Demonstration Partnership/No Cost Extension Form

Form Use:

The FDP/No-Cost Extension form is used to request additional time to complete the original scope of a project, utilizing existing funds available on a grant award issued by a federal granting agency participating in the Federal Demonstration Partnership (FDP) which formally incorporates the terms and conditions of FDP.  

Please Note:

• This form is not to be used for any other awards, but only for FDP awards.
• For NSF awards, use FastLane only.

Form Submitted:

Please submit the FDP/No cost Extension Form to:

• OCGA for General Campus and Health Sciences.
• SIO Contract and Grant Office for SIO.

Form Access:

• PDF
• Excel
• FDP/No Cost Extension Form Instructions

Form Name:

Request for Extramural Support Space Addendum

Form Use:

The RES Space Addendum is only used by the Scripps Institution of Oceanography (SIO) departments to identify if any additional space will be required for either personnel or equipment other than what is specifically listed under questions A, B, and/or C of the RES form. In addition, this form is useful if the proposal is awarded, and if additional space would be needed if the project is renewed.

Form Submitted:

Please submit the RES Space Addendum to the SIO Contract and Grant Office as part of the proposal package.

Form Access:

• PDF
• Excel

Form Name:

Request for Equipment Matching Commitment

Form Use:

The Equipment Matching Form is used when question "H" is answered "Yes" on the RES form. Departments that utilize this form include:

• Bioengineering
• Computer Science and Engineering
• Electrical and Computer Engineering
• Mechanical and Aerospace Engineering
• Structural Engineering
• Chemistry and Biochemistry
• Mathematics
• Physics

Form Submitted:

Please submit the Equipment Matching Form to OCGA as part of the proposal package.

Form Access:

• PDF

Form Name:

700-U - Statement of Economic Interests for Principal Investigators

Form Use:

The 700-U form is required for Non-Federal Sponsored Projects, which include:

• Gifts
• Private Grants
• Clinical Trial Agreements
• Lab Service Agreements
• For Profit Contracts, which include:
• Research Agreements
• UC Discovery Grant Program, which includes;
  • MICRO - Microelectronics
  • bio - Biotechnology
  • com - Communications and Networking
  • dig - Digital Media
  • ele - Electronics Manufacturing and New Materials
  • itls - Information Technology for Life Sciences

Please Note: Material Transfer Agreements (MTA); please fill out the appropriate Material Transfer Process form first, before proceeding with the 700-U, as the 700-U may not be required.

For information regarding Sponsors that may be exempt from 700-U requirement, click here.

Form Submitted:

The 700-U must be completed and submitted with the funding proposal to the appropriate reviewing office:

• OCGA - Office of Contract and Grant Administration:
  • For-Profit Research Agreements
  • Private Grants; such as UC Discovery Grant Program
  • Material Transfer Agreements for General Campus and Health Sciences
• SIO - Scripps Institution of Oceanography, Contract and Grant Office:
  • For-Profit Research Agreements and Private Grants, at SIO
• Health Sciences Office of Clinical Trial Administrative Services:
  • Clinical Agreements
• Health Sciences Legal Liaison:
  • Lab Service Agreements
• Office of Gift Administration:
  • Unrestricted gifts

Please Note: An original signature is always preferred, however faxed signatures will be accepted.

Form Access:

• PDF
• Form Overview
• Form Instructions
• Conflict of Interest Web site

Form Name:

9510 - Disclosure of Financial Interests Related to Federal and Other Sponsored Projects Adopting the Federal Requirements

Form Use:

The 9510 form is required for contract and grant proposals being submitted to:

• National Institutes of Health (NIH):
  • New
  • Renewal
  • Resubmission
  • Continuation
  • Competitive Supplement
  • Change of Principal Investigator
  • Adding a Researcher to the Project
  • Subaward
  • SBIR - Small Business Innovation Research
  • STTR - Small Business Technology Transfer
  • For detailed information on NIH policy regarding Conflict of Interest, click here.

• Department of Health and Human Services (DHHS): 8 agencies within DHHS, including NIH, require the 9510 form. Those DHHS agencies are:
  1. AHRQ - Agency for Healthcare Research and Quality
  2. ATSDR - Agency for Toxic Substances and Disease Registry
  3. CDC - Centers for Disease Control and Prevention
  4. FDA - Food and Drug Administration
  5. HRSA - Health Resources and Services Administration
  6. IHS - Indian Health Service
  7. NIH - National Institutes of Health
  8. SAMHSA - Substance Abuse and Mental Health Services Administration

• National Science Foundation (NSF):
  • New
  • Renewal
  • Change of Principal Investigator
  • Adding a Researcher to the Project
  • For detailed information on NSF policy regarding Conflict of Interest, click here.

• American Cancer Society (ACS):
  • New
  • Resubmission
  • Change of Principal Investigator
  • Add Researcher to the Project
  • For further information regarding Conflict of Interest for ACS, click here.

• American Heart Association (AHA):
  • New
  • Resubmission
  • Change of Principal Investigator
  • Add Researcher to the Project
  • For further information regarding Conflict of Interest for AHA, click here.

• California Institute for Regenerative Medicine (CIRM):
  • New
  • Resubmission
  • Change of Principal Investigator
  • Add Researcher to the Project
  • For further information regarding Conflict of Interest for ACS, click here.

• UC Discovery Grant Program: MICRO, bio, com, dig, ele, itls:

  • New
  • Resubmission
  • Change of Principal Investigator
  • Add Researcher to the Project

• UC Programs:

  • Breast Cancer Research Program (BCRP)
  • California HIV/AIDS Research Program (CHRP)
  • Tobacco-Related Disease Research Program (TRDRP)
    • New
    • Resubmission
    • Change of Principal Investigator
    • Add Researcher to the Project

• Subawards:
  • Applies to entities with funds originating from all agencies mentioned above; NIH, the 8 DHHS agencies, NSF, AHA, UC Discovery Grant Program and UC Programs; BCRP, CHRP, and TRDRP.
  • Please Note: The receiving entity is required to supply assurances that will allow the University to comply with NIH, NSF, some DHHS agencies, AHA, UC Discovery Grant Program, and UC Programs BCRP, TRDRP, and UARP regulations.

Form Submitted:

The 9510 must be completed and submitted with the funding proposal to the appropriate reviewing office:

• Office of Contract and Grant Administration (OCGA):
  • General Campus and Health Sciences proposals
• Scripps Institution of Oceanography Contract and Grant Office:
  • SIO proposals
• Health Sciences Sponsored Projects Pre-Award Office (HSSPPO):
  • Health Sciences NIH Grant proposals only

Please Note: An original signature is always preferred, however faxed signatures will be accepted.

Form Access:

• PDF
• Excel
• Form Overview
• Conflict of Interest Web site

Form Name:

Addendum to Investigator's Statement of Economic Interest

Form Use:

The Addendum to Investigator's Statement of Economic Interests is required when a Principal Investigator, Co-Principal Investigator, or Key Personnel have made a positive disclosure of financial interest on the 700-U form or the 9510 form.

Form Submitted:

The Addendum can be submitted either with the proposal in the case of a Contract or Grant (including UC Discovery Grant Program) or directly to the Conflict of Interest Office after the proposal is submitted by the Office of Contract and Grant Administration (OCGA), Scripps Institution of Oceanography Contract and Grant Office (SIO), or the Health Sciences Sponsored Projects Pre-Award Office (HSSPPO).

Please Note: In the case of Gifts or Service Agreements, the Addendum may be submitted directly to the Conflict of Interest Office.

Form Access:

• PDF
• Conflict of Interest Web site

Form Name:

Clinical Trial Agreement Request Form

Form Use:

The Clinical Trial Agreement Request form is used to gather pertinent information regarding the clinical trial on the principal investigator, the external sponsoring organization, and the proposed study. If the subject or their insurance carrier are to be billed for any of the services required by the protocol, the Clinical Trial Agreement Request Addendum must also be completed.

Form Submitted:

Please submit the Clinical Trial Agreement Request form to the Clinical Trial Administrative Services and Research Compliance Office (CTAS) Office; Mail Code 0706.

Form Access:

• Word

Form Name:

Clinical Trial Agreement Request Addendum

Form Use:

The Clinical Trial Agreement Request Addendum is used if the subject or their insurance carrier are to be billed for any of the services required by the protocol.

Form Submitted:

Please submit the Clinical Trial Agreement Request form to the Clinical Trial Administrative Services and Research Compliance Office (CTAS) Office; Mail Code 0706.

Form Access:

• Excel

Form Name:

University of California HIPAA Authorization Form

Form Use:

University of California HIPAA Authorization Form is used to protect the use and release of patient health information in compliance with federal and California state laws.

Form Submitted:

Please submit the University of California HIPAA Authorization Form:

• For an Industry-Initiated Clinical Trials, please submit the University of California HIPAA Authorization Form to the Clinical Trial Administrative Services and Research Compliance Office (CTAS) Office; Mail Code 0706.
• For an Investigator-Initiated Clinical Trials, please submit the University of California HIPAA Authorization form to the Human Research Protections Program Office; Mail Code 0052. A copy is also sent to the Office of Contract and Grant Administration; Mail Code 0934.

Form Access:

• Word - English
• Word - Spanish
• Word - VA Only

Form Name:

Institutional Research Bulk Account Application Form

Form Use:

The Institutional Research Bulk Account Application form is used to set-up a bulk account, which allows researchers to "receive charges" for clinical trial research related care, services and activity. This will ensure that the charges are posted to the Researcher's account and not be billed to the participant or a third party payer.

Form Submitted:

Please submit the Institutional Research Bulk Account Application:

• For an Industry-Initiated Clinical Trials, please submit the Institutional Research Bulk Account Application form to Patient Financial Services; Mail Code 8937.
• For an Investigator-Initiated Clinical Trials, please submit the Institutional Research Bulk Account Application form to Patient Financial Services; Mail Code 8937. A copy is also sent to the Office of Contract and Grant Administration; Mail Code 0934.

Form Access:

• Excel
• PDF - Sample

Form Name:

Indirect Cost Budget Estimator - for 12 Months

Form Use:

Created as an Excel file, this form will assist you in estimating your budget for periods of performance that are 12 months in length. By filling in the "Red" numbers, the "Blue" numbers will be automatically calculated according to the pre-programmed formulas. For more useful information on indrect cost rates and how they are calculated, click here.

Form Access:

• Excel

Form Name:

Indirect Cost Budget Estimator - not for 12 Months

Form Use:

Created as an Excel file, this form will assist you in estimating your budget for periods of performance other than 12 months. By filling in the "Red" numbers, the "Blue" numbers will be automatically calculated according to the pre-programmed formulas. For more useful information on indrect cost rates and how they are calculated, click here.

Form Access:

• Excel

Proposal Form Packages:

The Proposal Form Packages were created to offer our users a simpler way to fill out their proposal forms. Each package begins with the RES form, with other appropriate forms following in succession depending on the proposal package that is selected.

As the RES form is being filled out online, various fields, throughout the rest of the package, will populate with the same information that was typed in on the RES form, thus alleviating the task of having to fill out the same information several times.

The proposal form packages are available in PDF format, with the exception to Packages #5, #7, and #8, which are also available in Excel. Each form within the package offers instructions or an overview to assist users with filling out the forms within the package.

Please Note: If you wish to save one of the PDF proposal packages after working on it, you must have the purchased "professional" version of Adobe Acrobat 5.0 or above, otherwise your work will be lost after closing the file. Adobe Acrobat Reader is not capable of saving PDF files.

Package #1

398 NIH General Campus Package:

• RES Form
• PI Assurance Form
• PHS 398 Face Page
• COI 9510 Form

Package #2

398 NIH Health Sciences Package:

• RES Form
• PI Assurance Form
• PHS 398 Face Page
• COI 9510 Form

Package #3

2590 NIH General Campus Package:

• RES Form
• PHS 2590 Face Page
• COI 9510 Form

Package #4

2590 NIH Health Sciences Package:

• RES Form
• PHS 2590 Face Page
• COI 9510 Form

Package #5 - PDF

Package #5 - Excel

General Campus / Health Sciences Generic Package:

• RES Form
• UCSD Proposal Signature Page
• COI 700-U Form

Package #6

Scripps Institution of Oceanography Standard Form 424 Package:

• RES Form
• RES Space Addendum
• UCSD Proposal Signature Page
• Standard Form 424

Package #7 - PDF

Package #7 - Excel

Scripps Institution of Oceanography 700-U Package:

• RES Form
• RES Space Addendum
• UCSD Proposal Signature Page
• COI 700-U Form

Package #8 - PDF

Package #8 - Excel

Scripps Institution of Oceanography 9510 Package:

• RES Form
• RES Space Addendum
• UCSD Proposal Signature Page
• COI 9510 Form

Package #9

Scripps Institution of Oceanography 398 NIH Package

• RES Form
• RES Space Addendum
• PI Assurance Form
• PHS 398 Face Page
• COI 9510 Form

Package #10

Scripps Institution of Oceanography 2590 NIH Package

• RES Form
• RES Space Addendum
• PHS 2590 Face Page
• COI 9510 Form

Package #11

NSF General Campus / Health Sciences 9510 Package

• RES Form
• COI 9510 Form

Some of the Federal agencies supply their own forms to use to complete proposal applications, however many Federal agencies do not. Always check with the Federal agency that you plan to submit your proposal to. For example:

National Institutes of Health (NIH) - Public Health Service (PHS):

Grants:

NIH supplies all of the forms necessary to complete the proposal application. For access to all NIH/PHS forms, click here. Below are some of the forms and tools to begin the NIH proposal process.

• PHS 398 Forms:
  • PHS 398 Application Kit
  • PHS 398 Face Page - UCSD Information Pre-Populated

• PI Assurance Form:
  • PDF
  • Excel
  • This form is also contained within NIH Proposal Forms Packages 1, 2, and 9.
• Fellowship Assurance Form:
  • PDF
  • Excel

The National Institutes of Health Assurance Statement for Principal Investigators or PI Assurance form is required for all Principal Investigators submitting New and Renewal proposals to NIH.

• Modular Budget Estimator: For your convenience, OCGA has developed an Excel file, called the Modular Budget Estimator, that will assist you in estimating your budget. By filling in the "Red" numbers, the "Blue" numbers will be automatically calculated according to the pre-programmed formulas.

• PHS 2590 Forms:
  • PHS 2590 Application Kit
  • PHS 2590 Face Page - UCSD Information Pre-Populated

• NIH Proposal Forms Packages:
  • 6 NIH Proposal Forms Packages have been created to offer our users a simpler way to fill out a few of the necessary forms that are part of the proposal process. Each package begins with the RES form, followed by the appropriate Face Page, and COI 9510 form. As the RES form is being filled out online, various fields, throughout the rest of the package, will populate with the same information that was typed in on the RES form, thus alleviating the task of having to fill out the same information several times.

Contracts:

• Please Note: This form is for General Campus and Health Sciences. For SIO, please contact your SIO NIH contract analyst.
• NIH-2043 Proposal Summary and Data Record - UCSD Information Pre-Populate

National Science Foundation (NSF):

• Forms are all created using FastLane. For more information regarding FastLane, click here.

Office of Naval Research (ONR):

• Does not supply any forms for the completion of a proposal application. The UCSD Proposal Signature Page and UCSD Proposal Budget Form are used for ONR proposal submission.

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State of California departments each supply their own unique application forms for use when submitting proposals.  Please always check with the particular State agency that you plan to submit to for specifics.

Please Note: There is no Conflict of Interest requirement for the State of California agencies.

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University of California (UC) Programs each supply their own unique application forms for use when submitting proposals.  Please always check with the particular UC Program that you plan to submit to for specifics.  Such application forms are usually accessible on their Web sites.

Please Note: The following UC Programs require submission of the Conflict of Interest 9510 form:

• UC Discovery Grant Program:
  • MICRO, bio, com, dig, ele, and itls
• UC Programs:
  • Breast Cancer Research Program (BCRP)
  • Tobacco-Related Disease Research Program (TRDRP)
  • University-Wide AIDS Research Program (UARP)

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Non Profit agencies each supply their own unique application forms for use when submitting proposals.  Please always check with the particular Non Profit agency that you plan to submit to for specifics.  Such application forms are usually accessible on their Web sites.

Please Note: A Conflict of Interest 700-U form is required for most Non Profit agencies.  For a complete list of Non Profit agencies that are exempt from this requirement, click here.  The PI and Co-PI must complete and sign separate 700-U forms.

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For Profit Industry companies generally do not have specific application forms for use when preparing/submitting  proposals.  As such, the proposal can consist of the UCSD Proposal Signature Page, a text, and a budget, plus any additional items that may be applicable.  

When responding to an actual written request for a proposal from a For Profit Industry company there may be specific forms to complete and these will generally be included in the request.

Please Note: A Conflict of Interest 700-U form is required for all For Profit Industry agencies.  The PI and Co-PI must complete and sign separate 700-U forms.

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Foreign agencies each supply their own unique application forms for use when submitting proposals.  Please always check with the particular Foreign agency that you plan to submit to for specifics.  Such application forms are usually accessible on their Web site.

Please Note: a Conflict of Interest 700-U form is required for all Foreign agencies.  The PI and Co-PI must complete and sign separate 700-U forms.