Grant Pre-award Intake Form

This form contains logic, so please ensure all required fields are completed.

General Submission Information

New, Resubmission, or Supplemental?*

Is your submission new, a resubmission, or a supplemental?

Yes

Please Email Pedspreaward@UCDenver.edu

This form may only be used for new, resubmission, and supplemental submissions. Please contact Pedspreaward@UCDenver.edu with your request. Please ignore the budget attachment below.

Today's Date*

Submitter's Name*

Submitter's Email Address*

Please confirm the spelling.

PI Last Name*

PI First Name*

Section*

Select

Does the Proposal Require a Mentor?*

Yes

Mentor's Name*

Mentor's Section*

Title of Your Proposal*

Sponsor*

National Institutes of Health

Department of Defense

Other

Specify Other Sponsor

Sponsor's Admin Contact Name and Email (if known)

eBRAP Log Number or Identifier

If possible, provide the eBRAP log number or identifies from a pre-application. eBRAP log numbers are two letters followed by six numbers. If you are a Partnering PI on a multiple-PI proposal, it will be followed by 'P' and another number.

NIH Component and Center to Review the Proposal*

(e.g. NIDDK)

Is CU a subaward from the sponsor listed above?*

Yes

Who Is the Primary Sponsor?*

(i.e. NIH, DOD, CDC, FDA, name of foundation, state)

Due Date to Sponsor*

Type of Submission*

New

Resubmission

Supplemental

Federal Identifier from Previous Submission*

The Federal Identifier may be found on the NIH summary of the previous submission. Enter N/A if your submission does not have a Federal Identifier.

Funding Opportunity Announcement

(e.g. RFA-HL-22-011) Type in the funding opportunity announcement here or attach PDF in the drag-drop "attachments" box at the bottom of the form.

Provide Sponsor Website URL

(e.g. foundation, association, state)

User ID and password if required by sponsor

Start Date of the Proposed Project*

End Date of the Proposed Project*

Primary Project Location (Building and Room/Floor)*

Identify the site/location/building where the majority (50% or more) of UCD's portion of the work will be performed.

Will subcontractors be included in this proposal?*

Yes

List subcontractors, admin contact name, and email*

List each subcontractor and their administrator contact information.

Will there Be Children's Hospital Cost?*

Will the proposed project involve employees or other services at Children’s Hospital Colorado?

Yes

Research Protocols and Authorizations

Human Subjects Research (HSR)*

Does the proposed project involve human subjects research? If you are unsure if your study qualifies as human subjects research, review the definitions of human subjects research and clinical trials at https://grants.nih.gov/policy/humansubjects/research.htm

Yes

COMIRB Protocol Number*

You do not need an approved protocol at the time of application. If the approval is pending, please answer "pending" and skip the date field.

Most Recent COMIRB Approval Date

Provide the most recent new approval or continuing review approval date (must be within the last year).

Classify the Research Focus*

Adult Research (age 18 years and older)

Child Health Research (age < 18 years)

Both Child Health and Adult Research

Not Applicable, Fundamental Research

Is this a Clinical Trial?*

If yes, a grant specialist will contact you to obtain additional information.

Yes

Predominate Type of Work Being Conducted*

Basic and Early Translational Research (also called fundamental or bench research): Research that provides the foundation of knowledge for the applied science that follows. This type of research encompasses scientific disciplines such as biochemistry, microbiology, physiology, cell biology, molecular biology, neuroscience, bioengineering, and pharmacology, and their interplay, and involves laboratory studies with cell cultures and animal model systems, as well as molecular/biochemical studies utilizing human specimens (including -omic studies) that address fundamental mechanisms of physiological function and disease. Additionally, this can include computational modeling, molecular epidemiology, and experimentation in other nonhuman model systems. Basic science also increasingly extends to behavioral and social sciences. Etiologic, Mechanistic and Clinical Efficacy Research: Research with human subjects that is focused on individual patients. Research conducted with human subjects (or on material of human origin such as tissues, DNA, specimens, and cognitive phenomena) for which an investigator (or colleague) directly interacts with human subjects or with individual subject’s data. Excluded from this definition are in vitro studies that utilize human tissues that cannot be linked to a living individual. Clinical Research includes: (a) mechanisms of human disease, including basic experimental studies in humans, (b), prevention and therapeutic interventions in controlled settings, (c) classical clinical trials, (d) development of new technologies evaluated at the individual human subject level and e) observational epidemiologic research. Health Services, Outcomes and Clinical Effectiveness Research: Research which studies the end results (outcomes) of the structure, processes and service delivery of the health care system on the health and well-being of patients and populations. This would include: a) epidemiological research modeling predictors of patient outcomes, b) pragmatic trials of preventive or therapeutic interventions in real world settings, c) studies of implementation and dissemination of evidence-based health care interventions, and d) epidemiologic surveillance studies

Basic and Early Translational Research (fundamental or bench research)

Clinical Effectiveness, Outcomes and Health Services Research (healthcare system outcomes)

Etiologic, Mechanistic and Clinical Efficacy Research (individual health outcomes)

Purchase of Genomic Arrays Required?*

Also known as microarrays or bead arrays, genome arrays are a process to examine a piece of DNA on a glass slide to detect the different variants of sequence in the genome for the purpose of identifying/mapping variants.

Yes

Dollar Amount for Required Genomic Arrays*

Estimated dollar amount for the required genomic arrays.

Is Vertebrate Animal Research Involved?*

Yes

IACUC Protocol Number*

You do not need an approved protocol at the time of application. If the approval is pending, please answer "pending" and skip the date field.

Most Recent IACUC Approval Date

Provide the most recent new approval or continuing review approval date (must be within the last year).

Are there Radioactive Materials?*

Yes

Authorization Number(s) for Radioactive Materials*

You do not need an approved authorization at the time of application. If the authorization is pending, please answer "pending" and skip the date field.

Most Recent Radioactive Materials Approval Date*

Are there Biohazards?*

Yes

Biohazards (select all that apply)*

Select

Specify Other Biohazards*

Authorization Number(s) for Biohazards*

You do not need an approved authorization at the time of application. If the authorization is pending, please answer "pending" and skip the date field.

Most Recent Biohazards Approval Date*

Are there Chemical or Mineral Hazardous Materials?*

Yes

Chemical or Mineral Hazardous Materials **

Select all that apply.

Select

Specify Other Materials*

Authorization Number(s) for Hazardous Materials*

List authorizations for all chemical or mineral hazardous materials. You do not need an approved authorization at the time of application. If the authorization is pending, please answer "pending" and skip the date field.

Most Recent Hazardous Materials Approval Date*

Dual Use Research of Concern (DURC)?*

Is any agent or toxin in the proposed project classified as a DURC? For information, see http://www.phe.gov/s3/dualuse/Pages/default.aspx

Yes

Export Control - Check All that Apply*

For more information, see https://research.cuanschutz.edu/regulatory-compliance/home/export-control/export-control-home

Select

Budget

A detailed budget is required for the internal routing. Please provide general information about personnel and other costs. The Pre-award Grants Specialist will prepare a draft budget for your review.

How Will You Detail the Budget?*

In this form

Attach a document in the drag-drop box at the end of this form

Budget Details*

Provide a list of (1) personnel, roles and their percent of effort each year (2) an estimate of other direct costs, such as supplies, animals, participant incentives, core facility services and Children’s Hospital costs (3) an estimate of any sub-recipient or consultant costs per year.

Attachments*

Attach Draft Budget, Budget Justification, Funding Opportunity Announcement, and any other pertinent files. PDF or Word document preferred.

Drag and drop files here or

Additional Notes for this Submission

Send me a copy of my responses

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