CNSI Proposal Request Form

Please submit this form as soon as you know that you are going to develop a proposal.


Contact the Contract and Grants Team for any questions: cg@cnsi.ucsb.edu

General Intake Information

Will UCSB be a subcontract?*

(Please check all that apply)


Proposal drafts need to be submitted to the Office of Research 7 business days before the deadline to receive a full review. Otherwise, they will receive an expedited review.

Please also include any pertinent email correspondence with the Program Officer or equivalent.

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Please include brief details as applicable

Assurances

Will any human subject research be conducted on this proposal?*

"Human subjects" means a living individual about whom an investigator conducting research: 1) Obtains information or biospecimens through intervention or interaction with an individual, and uses, studies, or analyzes the information or biospecimens; or 2) Obtains, uses, studies, analyzes, or generates identifiable private information or identifiable biospecimens.

Will any of the H.S. research be performed at UCSB or by UCSB personnel?*
For federally supported proposals which require a Single IRB (sIRB) review, does this project involve multiple US institutions conducting non-exempt human subjects research at more than one domestic site?*

If Yes, IRB review fees may need to be included in the budget proposal.

For federally supported or FDA-regulated proposals, does this project involve a clinical trial?*

Answer “yes” if (1) the project involves one or more human subjects, (2) who are prospectively assigned to one or more interventions and (3) the study is designed to evaluate the effect of the intervention on participants, (4) in a health-related behavioral or health-related biomedical outcome.

Does this research involve the use, collection, or analysis of data covered under (i.e.,) Protected Health Information (PHI)?*

Protected Health Information includes any information about health status collected, created, maintained, or transmitted by a “covered entity” (such as a health care provider or health care facility) and can be linked to a specific individual. Examples of PHI include, but are not limited to, demographic information (age, name, gender, etc.), medical diagnosis, treatment information, medical test results, etc.

Does this research involve the use, collection or analysis of Personally Identifiable Information (PII)?*

Identifiable Information includes any information that can be used to identify, contact, or locate a single person or can be used with other sources to identify a single individual. Examples of PII include, but are not limited to, name, date of birth, address, telephone numbers, social security number, photographic image, finder or voice print, or other unique characteristics.

If the proposal is being submitted to PHS/NIH, will the research generate large scale human and/or non-human genomic data?*

If Yes, a Genomic Data Sharing plan needs to be included with the proposal. Large scale genomic data includes phenotypic data, genome wide association studies (GWAS), single nucleotide polymorphisms (SNP)arrays, genomic sequencing, transcriptomic metagenomic and epigenomic data, gene expression data, and any use of that data for future research. If the proposal involves sharing human data, then you will need to obtain an Institutional Certification from the Research Integrity Office to assure compliance with NIH regulations. You are encouraged to contact a Research Integrity Specialist (researchintegrity@research.ucsb.edu) at the initial “Just in Time” notification to obtain the Certification.

Does this proposal involve any use of vertebrate animals?*

Answer "yes" if your study includes the direct and/or indirect use of vertebrate animals for research and/or teaching purposes. All such studies must be overseen by the IACUC. If your proposal includes the use of vertebrate animals and you do not yet have an approved protocol, or if you are unsure of whether the animal use in your proposal requires IACUC oversight, please contact the IACUC Office at iacuc@lifesci.ucsb.edu. Please note that receiving an award, or IACUC approval of your protocol, does not guarantee animal housing or procedure space in the Animal Resource Center, satellite facilities, or Natural Reserves. Contact the appropriate facility manager to determine availability.

Will the use of any vertebrate animals occur on UCSB property or by UCSB personnel?*
Have you discussed animal housing needs with the ARC Director?*
Is there a subawardee associated with this award that will be working with vertebrate animals?*
Will Human Stem Cells be used?*

Answer “yes” if your study includes the use of gametes, blastocysts, derivation and/or use of human embryonic stem cells (hESCs), embryonic or fetal germ cells, adult and fetal stem cells, or human induced pluripotent stem cells. Do not check “yes” if you are using adult tissue-specific stem cells such as hematopoietic cells or mesenchymal cells, unless they are being induced to differentiate into the three major germ lines.

For NIH proposals, does the use of stem cells involve human fetal tissue (HFT) derived from an elective abortion?
Will the project involve any hazards?*

Chemicals (solids, liquids, or gases); Radioactive materials; X-ray producing machines; Non-ionizing radiation (lasers, UV, microwave); Biosafety Level 2, Level 3, or “Select” Biological agents; Recombinant DNA; Human/primate tissues or fluids; Animals or animal tissue/fluids; Research divers/dive equipment/small boats; Controlled Substances(DEA Schedule I-IV)

Will additional space or alterations be necessary for this project?*

NOTE: Any use of Natural Reserve Systems sites, whether ongoing or new, is considered additional space and requires NRS approval.

Does the proposed research involve any foreign elements?*

Foreign sponsor, foreign collaboration, foreign sub-recipient(s), or international shipments of any commodities or technology (e.g. materials, software, etc.). Additionally, does the proposal involve travel to Cuba, Iran, Syria, Sudan, North Korea, Ukraine (Crimean Region) or research at any listed country by UCSB personnel? Please contact Research Integrity staff at exportcontrol@research.ucsb.edu for any questions regarding this assurance.

Does the proposed/funded research involve collaborations with or travel to any of these countries: Cuba, Iran, Syria, Sudan, North Korea, Ukraine (Crimean Region)?*
Does the proposed/funded research involve the transfer/shipment of technical information, equipment, items or materials (e.g., sending project deliverables) to international destinations?*
Does the proposed/funded research involve a foreign sponsor, foreign collaborator(s), foreign subcontract(s), financial support to a foreign entity or other foreign entities (e.g. non-US Company, University or other organization)?*
Is the proposal being submitted to a federal sponsor (or a federal flow-through sponsor)?*

If yes, the federal sponsor may impose certain requirements related to foreign involvement. Please review the sponsor’s policies to determine to what extent they require disclosure of external sources of support (including in-kind), as well as outside activities, affiliations, and collaborations; pay special attention to foreign disclosure obligations. Please visit the Sponsored Projects’ webpage (https://www.research.ucsb.edu/foreign-involvement-disclosure-requirements) to review the requirements for the particular sponsor to whom you are submitting. For background on foreign involvement, please visit Research Integrity’s webpage: https://www.research.ucsb.edu/research-integrity/international-engagement. If you have any questions on this matter, please contact the SPO team assigned to your department.

Has the PI or any other employee or student participating in this project purchased, or do they plan to purchase or to use, any telecommunications or video surveillance equipment or services produced or provided by Huawei Technologies Company, ZTE Corporation, Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities)?*

The use of such equipment and services extends to use for any University-related purpose, whether in the performance of a sponsored research project or otherwise. The equipment and services referenced in this paragraph include personal devices, such as cell phones, when they are used for research purposes or as a substantial or essential component of a system.

Will this project include one or more subawards?*
Will requested funds be considered flow-through? (Who is the ultimate source source of funds?)*

If yes, the federal sponsor may impose certain requirements related to foreign involvement. Please review the sponsor’s policies to determine to what extent they require disclosure of external sources of support (including in-kind), as well as outside activities, affiliations, and collaborations; pay special attention to foreign disclosure obligations.

Is the proposal being submitted to a non-government sponsor, or supported in part by a non-government flow-through sponsor?*

(Note: State institutions of higher education are considered government entities)


If Yes, and either sponsor or prime sponsor are not exempt from this requirement per the guidance above, Principal Investigators must complete the ‘700U - Statement of Economic Interests for Principal Investigators’ disclosure through the O.R.’s Conflict of Interest disclosure system - ORCOI at http://ucsb.coi-smart.com if/when the proposal is funded.

Is proposal being submitted to the NSF (including NSF flow-through funding) or any other program requiring similar Federal Financial disclosure?*

If Yes, the lead PI must submit a Design, Conduct, and Reporting Form (DCR, which prints with the Datasheet) to the Conflict of Interest Coordinator. Additionally, all personnel listed on the DCR Form must complete 'The NSF Annual Disclosure Form' through OR's Conflict of Interest system.

Is the proposal being submitted to the PHS/NIH (including PHS/NIH flow-through funding) or any other sponsor requiring similar PHS/NIH financial COI disclosure?*

If Yes, the lead PI must submit a Design, Conduct, and Reporting Personnel Form (DCR, which prints with the Datasheet) to the COI Coordinator via e-mail (coi@research.ucsb.edu). Additionally, all personnel listed on the DCR Personnel Form must (1) complete 'The PHS Annual Disclosure Form' through O.R.’s Conflict of Interest Disclosure System at http://ucsb.coi-smart.com and (2) take the Compliance & Conflict of Interest for Researchers Briefing (COIR) through the campus’s Learning Management System (LMS).

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