THE UNIVERSITY OF
Office of Research
Transmittal
Form Instructions
A. Introduction
UMC grants and contracts
are legally constituted only when signed by the Vice Chancellor for Health
Affairs or his authorized representative. This signature indicates that the
grant or contract is in compliance with all regulations. The Transmittal Form is used to document the
approval of the various offices and committees that are responsible for the
implementation of compliance regulations.
B. When to use this transmittal form
Transmittal forms must be completely signed before
the document is submitted to any outside funding agency including:
·
Industry and
private sponsors
·
State and
Federal agencies
·
Non-government
agencies
·
Volunteer
health organizations (AHA, ACS, etc.)
·
Non-profit
organizations and foundations
A transmittal form is required for the following
documents:
·
all new applications/proposals for sponsored programs
ü
Transmittals
are no longer required for non-competing continutations of sponsored programs
·
Material
Transfer agreements (Use Transmittal for MTA’s) http://dor.umc.edu/RT/Forms/MTAtransmittal.pdf
·
Memoranda of
Understanding
·
Preproposals,
white papers, letters of intent, etc.
-
if an authorized institutional representative is required to sign the document,
or
-
if a budget is included in the document, or
-
if a commitment of personnel or facilities is made.
C. Instructions for completing the transmittal
form
The PI is responsible for accurately completing the
transmittal form as outlined below:
Note:
In the upper right-hand
corner of the form, please provide the name and contact information (phone or email)
of the individual who should be notified after the proposal has been routed and
signed by the Associate Vice Chancellor for Research.
PROPOSAL INFORMATION
·
Enter the
contact person and pertinent information in the upper right corner of the form.
·
Enter the name
of the Principal Investigator, department, proposal title, funding source, projected dates
and effort. Please list project
personnel, their role, location and effort. If the application is for a student or
fellow, enter both the faculty member's and the student's name and the
designations- sponsor and student/fellow.
·
Enter the
source and purpose of the grant and indicate if it will be an electronic
submission.
LOCATION OF ACTIVITIES
·
Indicate the building(s) and room(s) that will
be utilized for the project. Indicate the
purpose, type, function of
activity, building, room number and type of space that best describes
the application.
·
Hospital Services
-
Determine if your project involves the use of
hospital services or patient care areas.
-
Indicate ‘No’ if hospital services or space are not used in your study.
-
Indicate ‘Yes’ if hospital services or space are involved then attach a
completed Research Plan Code form to you transmittal.
·
Physician Services
Someone
needs to write this part!
BUDGET
·
Enter the
start and stop dates (mm/dd/yy), direct costs, F&A costs for each budget
period requested. Fiscal totals will
calculate automatically.
·
Enter the
overall start and stop dates for the entire project.
·
Enter any
matching funds, required or voluntary to be used toward the project for
"in-kind" or real dollar contributions. (Note: "in-kind"
contributions refer to those costs associated with faculty commitment to a
project with no request for funds, i.e., salary, fringe and indirect costs,
prorated to percent effort.) All
matching funds must be approved by the Department Chair or Dean prior to
submission of the proposal to the Office of Research.
·
Indicate
whether the budget includes funds to be dispersed to subrecipients
(subcontractors) at other institutions.
ASSURANCES
·
Animals
-
Determine if
the activity involves animals as outlined in the "Laboratory Animal
Facilities Policies and Procedures Manual" (available from the Laboratory
Animal Facilities).
-
Indicate
"No" if the activity does not involve animals.
-
Indicate
"Approved" if the activity involves animals and your protocol has
been approved by the Institutional Animal Care and Use Committee (IACUC). Provide the IACUC protocol number and the
date on which it was approved.
-
Indicate
"Pending" if the activity involves animals and your protocol is
awaiting review by the IACUC.
**For more information regarding IACUC and its approval process, visit
the Office of Research website (http://research.umc.edu)
under "Institutional Compliance" or contact Jean Garrett at ext.
5-5000.
·
Human Subjects
-
Determine if
the activity involves human subjects as outlined in the "Institutional
Review Board Policies and Procedures Manual" (available online at: IRB home).
-
Indicate
"No" if the activity does not involve human subjects.
-
Indicate
"Approved" if the activity involves human subjects and your protocol
and informed consent form has been approved by the Institutional Review Board
(IRB).
-
Indicate
"Pending" if the activity involves human subjects and your protocol
is awaiting review by the IRB.
-
**For more information regarding the IRB review mechanism, visit the
Office of Research website (http://research.umc.edu)
under "Institutional Compliance" or contact Nancy Olson at ext.
4-2815.
·
Biohazards
-
Determine if
the activity involves recombinant DNA or other microbiological biohazards as
outlined in the "UMC Guidelines for Activities Involving Recombinant DNA
and/or Microbiological Biohazards" (available online at: http://dor.umc.edu/Biohazards.html
-
Indicate
"No" if the activity does not involve recombinant DNA or other
microbiological biohazards.
-
Indicate
"Yes" if the activity involves recombinant DNA or other microbiological
biohazards.
-
If you entered
"Yes," indicate whether your activity has changed since your last
approval.
-
If the
activity involves recombinant DNA, indicate the biosafety level required for
the activity. If the activity is exempt
from this requirement, mark "exempt".
Enter the date on which the IBC last approved this activity.
-
If the
activity involves other microbiological biohazards, indicate the biosafety
level required for the activity. Enter
the date on which the IBC last approved this activity.
**For more information regarding the IBC and its approval process,
visit the Office of Research website
http://dor.umc.edu/ under
"Institutional Compliance" or contact Steve Case, PhD. at ext.
4-1518.
·
Radiation
-
Determine if
the activity involves radioactivity using the guidelines outlined in the
"Radiation Safety Manual" (available from the Radiation Safety
Office).
-
Indicate
"No" if the activity does not involve radioactivity.
-
Indicate
"Approved" if the activity involves radioactivity and you have been
approved by the Radiation Safety Office to use the type of radioactivity
described in the proposal.
-
Indicate
"Pending" if the activity involves radioactivity and you are
currently in the process of obtaining approval for the use of radioactivity.
**For more information regarding radiation safety, visit the Office of
Research website (Office of Research) under
"Institutional Compliance" or contact., Vicki Tygart,Radiation Safety
Officer, at ext. 4-1078.
·
Conflict of Interest
-
Indicate
whether any of the investigators involved in the activity described in the
proposal have an actual, potential or perceived conflict of interest. The UMC Policy on Conflict of Interest can be
found in the Faculty and Staff Handbook and Personnel Procedures manual or
online at: http://dor.umc.edu/RT/policies/ConflictofInterest%2000.PDF.
CERTIFICATION
·
Principal Investigator: Enter the signature of the faculty member listed
at PI in the signature section or, if the application is for a student or
fellow, enter the signatures of both the faculty and the student or fellow
followed by the appropriate designations.
This signature indicates that the PI accepts responsibility and
accountability for proper conduct and financial management of the project.
·
Department Chairman: Enter the
signature of the PI's department chair.
The chair's signature indicates acceptance of supervisory
responsibility, commits facilities, states that the scientific and budget
reviews have been conducted, and agrees that the project is appropriate for the
department.
·
Dean/Designee: Enter the signature of the
dean of the PI's school. This signature is required for the Schools of
Dentistry, Health Related Professions, and Nursing. It is not required if the PI is a member of
the
·
Hospital Director: Enter the signature of the hospital director if
the project involves the use of any hospital area, hospital services, or any
employees for whom the hospital is the pay source. Projects which use tissue harvested at the
hospital and removed to another building for analysis also require hospital
approval. Contact Valerie Box at ext.
5-6397.
D. Instructions for routing your proposal
·
Submit the
following to the Office of Research
(Learning Resources U-020):
-
The
transmittal form with the original signatures
-
A copy of the
application (proposal, preproposal etc.)
-
A copy of the
sponsor's applicant instructions which (policies, application guidelines,
etc.). If you are submitting a proposal to NIH or NSF, it is not necessary to
provide the guidelines unless you are responding to an RFA.
-
If
radioactivity is involved, a completed copy of the "Request for Grant
Approval" form for submission to the Radiation Safety Office.
-
If recombinant
DNA and/or other microbiological hazards are involved, an additional copy of
the project description and any additional required forms as outlined in the
"Requirements for IBC Registration" available online at: http://research.umc.edu/institutional-biohazards-committee.html.
·
The Office of
Research will verify compliance for all areas listed under the ASSURANCES
section and obtain the remaining institutional signatures.
·
The contact
person identified at the upper right-hand corner of the transmittal will be
notified immediately after institutional representative signature has been
obtained. The principal investigator is
then responsible for:
-
mailing the
proposal to the funding agency and
-
providing the
Office of Research with an exact copy of the proposal as it was sent to the
sponsor within two weeks of submission.
If you have any questions regarding
the submission of your proposal for transmittal, contact the Office of Research
at ext. 5-5000.