BME Proposal Submission Request

PI Name(Required)

PI Department

Mentor Name(If applicable)

Proposal Title(Required)

Agency Name(Required)

Application Due Date(Required)

RFA# or PA# or URL

File (RFA or PA)

Max. file size: 7 MB.

Activity Code

Please check all certifications:

Human Subjects(IRB, WIRB)

Clinical Services(CLSVC)

Radiation & Radioactive Materials(RADIO)

Animal Subjects(IACUC)

Usage of Biohazards(BIOHZ)

Recombinant DNA(rDNA)

None

Project Type(Required)

Research-Applied (RSHA): Conducted to gain the knowledge or understanding to meet a specific, recognized need.

Research-Basic (RSHB): Undertaken primarily to acquire new knowledge without any particular application or use in mind.

Research-Developmental (RSHD): Systematic use of knowledge or understanding gained from research directed toward the production of useful materials, devices, systems or methods.

Research Training (RSHT): Support for research training and career development for pre- and post-doctoral individuals, for support of theses or dissertation, or other undergraduate scholarly activities.

Instruction (INSTR): Instruction activities benefitting the students of the University of Florida.

Other Sponsored Activity (OTHSP): Funding for activities not directly related to research, instruction and service.

Other

Clinical Trial
Is your proposal a Clinical Trial?
If Yes, will it be a Phase III Clinical Trial?
Does the study involve human participants?
Are the participants prospectively assigned to an intervention?
Is the study designed to evaluate the effect of the intervention on the participants?
Is the effect that will be evaluated a health-related biomedical or behavioral outcome?

BME/UF Personnel
Name	Role	Effort%

Cost Sharing
Does your grant application contain Cost Sharing or Effort Commitment with no salary support?

Subcontract
Does your grant application include a subcontract from an outside institution or agency?

Human Subjects Including Human Data and Tissue
Indicate if you will use any Clinical Services
Indicate if any member of the study team is employed by Gainesville UF health science center, Pharmacy, Vet Med, PHHP and/or the study plan includes any HSC facility
Indicate if you have any (a) direct interaction with subjects or (b) contact with identifiable human data or tissue
Indicate if you only use de-identified data or tissue
Will human subjects be prospectively assigned to a biomedical or behavioral intervention?
Will you collect any identifiable human data in a clinic, hospital, clinical research lab, or Clinical Research Center?
Will you analyze any existing health-related information or samples?

Proposal Descriptors
Is this proposal being considered for funding through a peer-reviewed process
If this project involves activities outside the US or partnerships with international collaborators, identify countries
For required institutional reporting purposes, provide keywords

Outside Institution(s)

Do you plan to do any of the following?
Travel or send anyone working on this project to a location outside the US for a meeting or conference?
Travel or send anyone working on this project a location outside the US for partner meetings?
Travel or send anyone working on this project to a location outside the US for field work?
Issue funds to a foreign subcontractor?
Establish any relationships or have any of the work executed by a foreign collaborator?
Establish a program or provide services outside the US?
Purchase any supplies, labor, equipment or other items while outside the US?
Other activities outside the US?

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Details