Biosciences Area Proposal Authorization Form

Biosciences Area Proposal Authorization Form

Complete the form below

This form is used for all New, Renewal, Resubmission, Supplemental, Amendment proposals and Pre-Applications or Concept Papers requiring institutional approval. Information on internal deadlines may be found here:

https://bsbkops.lbl.gov/services/proposals-budgets/pre-award-proposals

First Name*

Principal Investigator (PI)

Last Name*

Principal Investigator (PI)

Email*

Division & Department*

Select or enter value

Proposal Details

Application Type*

Select or enter value

Project Title*

Proposal nick name

Not to exceed 30 characters including spaces

Direct Sponsor*

The organization that will directly fund LBNL.

Direct Sponsor due date*

If LBNL is a subcontractor, assume a minimum of 2 weeks before the Prime Sponsor due date.

Is LBNL a subcontractor on another organization's proposal?

If Yes, complete Prime Sponsor questions below.

Yes

Prime Sponsor (ONLY REQUIRED when LBNL is a subcontractor)

List the primary source of funding (e.g., NIH, NASA, etc).

Prime Sponsor due date (ONLY REQUIRED when LBNL is a subcontractor)

Direct Sponsor Contact Information (Only required when LBNL is a subcontractor)

Please provide the Direct Sponsor's PI and/or administrative Point of Contact.

Funding Announcement # or website link*

If there is no announcement, state None.

For NIH proposals only

Please add NIH mechanism (e.g., R01, R21, P01, etc.)

Does the proposed work contain vertebrate animal use?*

The use of vertebrate animals by an off-site collaborator or vendor (e.g., for toxicity testing, or the production of custom antibodies) is Animal Use for the purposes of this application and must be reported here.

The use of pre-existing animal-derived products (e.g., cell lines or off-the-shelf antibodies) is not covered by the Animal Welfare Act and should NOT be considered Animal Use for the purposes of this application.

Yes

Does the proposed work involve human subjects?*

Examples of human subjects research include:

Collection or analysis of human biological specimens
Secondary uses of human data and/or specimens (including all Social Media and coded data)
Using humans to test devices or products (biometrics devices, imaging devices)
Surveys, interviews and focus groups
Cognitive and perceptual studies (human-computer interaction, decision science experiments)
Effects of environmental alterations (lighting, temperature) on comfort, behavior, or performance
Analysis of data collected through interaction with humans (PET scans, video/audio recording, imaging)
Educational or social science research
Human Terrain Mapping or projects that involve data gathering or analysis conducted for the military or intelligence purposes to understand social, cultural, or economic elements of people in countries where the U.S. military is operating
Such research conducted by others for LBNL under subcontract

Yes

Does the proposed work involve human specimens and/or data?*

Use of De-identified or Coded human data or specimens must be submitted to HARC for Not Human Subjects Research (NHSR) determination through this form.

If you check Yes to this question, please submit the form as soon as possible so the proposal can be accurately recorded in eSRA.

Yes

Does the proposed work include an outgoing subcontract(s)?*

Yes

Subcontractor Information

If you responded Yes to the question above, please provide the Organization Name and contact information (if known) of LBNL's subcontractors.

Certifications

Overlap*

To the best of my knowledge, the proposed work should be neither redundant with, overlap, nor create real or perceived conflicts of interest with other funded or proposed work in the Biosciences Area or other LBNL divisions as discussed with my Division Director. Enter "confirm" or identify any potential conflicts below.

Building Space*

The proposed work does NOT require any new or additional building space than you currently occupy. Enter "confirm" or identify any potential new or additional space which may be required here.

S&T Review Matrix*

Is the direct sponsor, prime sponsor or lead organization from a Country of Risk? For further information on DOE Order 486.1, see https://ops.lbl.gov/resource/doe-order-486/

Yes

Postive S&T Review responses

If you responded Yes above, please provide additional details which can be used in the evaluation of the review below.

For Fellowship Applications Only

Mentor First Name

Mentor Last Name

Mentor email address

Additional Comments

Please provide any additional relevant information not covered above.

File Upload

Example: an announcement which is not publicly available on the web.

Drag and drop files here or

Send me a copy of my responses

Privacy Notice|Report Abuse