Letter Of Intent To Enter Into A Federal Subaward Or Consortium Agreement Form
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2Grants Administration Policy and Procedures Manual
LETTER OF INTENT TO ENTER INTO A FEDERAL SUBAWARD
OR CONSORTIUM AGREEMENT
Applicant Institution (“Prime”) Information:
Applicant Institution: _________________________________ Prime PI: __________________________
PI Phone: _____________ FAX: ____________ E-mail: _____________ e-Commons ID: ____________
Prime Business Contact: _________________________ Phone: ______________ FAX: _______________
Subawardee/Cooperating Institution Information:
Cooperating Institution: __________________________________ FWA Assurance #: ________________
Cooperating PI Name: _____________________________ eRA Commons ID: ______________________
Cooperating PI Contact Info – Phone: _____________ FAX: _____________ E-mail: ________________
Business Contact: _________________________ Phone: ______________ FAX: _______________
DUNS #________________________________
Congressional District ____________
Proposed Subaward/Consortium Agreement Information:
Funding Agency: ____________________________ CFDA #: _________
Project Title: ____________________________________________________________________________
Budget Period: _________ to __________ Project Period: _________ to __________
Budget Direct Costs: $______________
Budget F&A Costs: $______________
0.00%
Project Total Costs: $________________ F&A Rate: _____________
NO
Human Subjects? (Pick One)
IRB Protocol #:______________ Date: _____________
YES
NO
Vertebrate Animals? (Pick One)
IACUC Protocol: ____________ Date: _____________
Conflict of Interest Policy: (check A or B)
___ A. Subawardee/Cooperating Institute has in effect an up-to-date, written, and enforced conflicts of interest
policy and administrative process (“COI Policy”) to identify and manage financial conflicts of interest
(“FCOIs”), which is consistent with the provisions of 42 CFR Part 50, Subpart F and 45 CFR Subtitle A, Part
94.
___ B. Subawardee/Cooperating Institute does not have in effect an up-to-date, written, and enforced conflicts
of interest policy and administrative process (“COI Policy”). If so, please check one of the following:
___ Subawardee/Cooperating Institute will adopt a policy compliant with federal regulations 42 CFR
Part 50, Subpart F and 45 CFR Subtitle A, Part 94 (a Model Policy will be provided upon request) prior
to funding.
___ Subawardee/Cooperating Institute will adopt Boston Medical Center/Boston University (Prime
Recipient) COI Policy. All subrecipient “Investigators,” or, any person, regardless of title or position,
who is responsible for the design, conduct, or reporting of research, as defined by Boston University and
Boston Medical Center policy, prior to submission of the research proposal application, will
complete disclosure and training via Boston University’s electronic Financial Interest Disclosure
module, eFind, by going to BU’s Conflict of Interest webpage at bu.edu/orc/coi/forms/.
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08/28/12
Grants Administration
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Parent category: Letters