CNSI Proposal Request Form

(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.

Please distinguish between funded and unfunded time.

Please distinguish between funded and unfunded time.

"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.

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

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.

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.

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.

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.

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.

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)

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

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.

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.

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.

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.

(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.

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.

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).