Nih Assurance Of Compliance Statement printable pdf download

Nih Assurance Of Compliance Statement

ORSP USE ONLY

UM Project Identifier:________________

Award No.:______________________

NIH ASSURANCE OF COMPLIANCE STATEMENT

Indicate which situation this As

surance of Compliance Applies to:

New Application/Competing Renewal

Annual Progress Report

Prior Approval Request

I certify that the statements here

in are true, complete, and accurate to

the best of my knowledge. I am aware that any false, fictitious, or

fraudulent statements or claims may subject me to criminal, civil, or

administrative penalties. If this is a proposal that results in an award, I

agree to accept responsibility for the scientific conduct of the project

and to provide the required progress reports in accordance with the

sponsor's requirements.

PI Signature

Date

Printed Name and Title

Date

Co-PI Signature

Printed Name and Title

Co-PI Signature

Date

Printed Name and Title

Co-PI Signature

Date

Printed Name and Title

Notes:

For Multi-Investigator Award, each PI employed at

The University of Montana must sign this form.

•

Stamps and per/for signatures will not be accepted under any circumstances.

This assurance is not required when using an internal OPAS form.

•

Form RA-105

Available online at

04/2006

Nih Assurance Of Compliance Statement