APPENDIX C
PROPOSAL PREFATORY MATERIALS
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COVER SHEET
(use additional pages as required)
NRA 95-OSS-15
ADVANCED INSTRUMENT CONCEPTS FOR A
NEAR-SUN FLYBY MISSION
INSTRUMENT TYPE(S):¹
DESCRIPTIVE TITLE OF INVESTIGATION:
PRINCIPAL INVESTIGATOR: Name/Title
Institutional address including telephone
Signature/Date
CO-INVESTIGATOR(S): (if any) Name(s) and Institutional Addresses(s)
INSTITUTIONAL AUTHORIZATION: Name/Title
Institutional address including telephone
Authorizing Signature/Date
TOTAL BUDGET SUMMARY:
- PERIOD OF PERFORMANCE (MONTHS) __________________
- RESEARCH TASK ($K): __________________
- ESTIMATED NCCS CU'S:² __________________
1) For example, Optical imager, Energetic Particle Detector,
Ion Mass Spectrometer, etc.
2) From p. C-6.
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PROPOSAL SUMMARY
DESCRIPTIVE TITLE OF INVESTIGATION: (use same title as on p. C-2)
PRINCIPAL INVESTIGATOR AND INSTITUTION:
CO-INVESTIGATOR(S) AND INSTITUTION(S):
___________________________________________
Special Instructions: Provide the following, typed single-
spaced:
(a) Overall objectives and strategy of the proposed
work;
(b) A brief description of what will be done and plan
of activities;
(c) Perceived relevance of proposed research to the
objectives stated in this NRA;
and
(d) If previously supported for similar work, recent
publications resulting from
research.
Note: The total length of items (a) through (d) may extend
to a second sheet if necessary. This same Summary may also
be used in as the Abstract for the proposal itself.
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BUDGET SUMMARY
FROM: _________________ to _______________________
TITLE OF INVESTIGATION:
PRINCIPAL INVESTIGATOR / INSTITUTION:
NASA USE ONLY
A B C
1. Direct Labor (salaries, wages, and
fringe benefits) ___________ __________ ____________
2. Other Direct Costs:
a. Subcontracts ___________ __________ ____________
b. Consultants ___________ __________ ____________
c. Equipment ___________ __________ ____________
d. Supplies ___________ __________ ____________
e. Travel ___________ __________ ____________
f. Other ___________ __________ ____________
3. Indirect Costs ___________ __________ ____________
4. Other Applicable Costs ___________ __________ ____________
5. Subtotal--Estimated Costs ___________ __________ ____________
6. Less Proposed Cost Sharing ___________ __________ ____________
7. Carryover Funds (if any)
a. Anticipated amount ___________ __________ ____________
b. Amount used to reduce budget ___________ __________ ____________
8. Total Estimated Costs ___________ __________ XXXXXXXX
APPROVED BUDGET XXXXXXX XXXXXXX ____________
____________________________________________________________________________
Instructions
1. Provide a separate Budget Summary sheet for each year of
the proposal research.
2. Grantee estimated costs should be entered in Column A.
Columns B and C are for NASA use only. Column C represents
the approved grant budget.
3. Provide in attachments to the budget summary the detailed
computations of estimates in each category, along with any
narrative explanation required to fully explain proposed costs.
------------- ADDITIONAL INSTRUCTIONS ON FOLLOWING PAGE -------------
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INSTRUCTIONS FOR BUDGET SUMMARY
1. Direct Labor (salaries, wages and fringe benefits).
Enclosures should list number and titles of personnel,
amount of time devoted to the grant, and rates of pay.
2. Other Direct Costs.
a. Subcontracts - Enclosures should describe the
work to be subcontracted, estimated amount, recipient
(if known), and the reason for subcontracting this
effort.
b. Consultants - Identify consultants to be used,
why they are necessary, time to be spent on the
project, and rates of pay.
c. Equipment - List separately and explain the need
for items of equipment exceeding $1,000. Describe the
basis for the estimated cost.
d. Supplies - Provide general categories of needed
supplies, the method of acquisition, estimated cost,
and the basis for the estimate.
e. Travel - List the proposed trips individually,
describe their purpose in relation to the grant,
provide dates and destinations where known, and
explain how the cost for each was derived.
f. Other - Enter the total of any other direct costs
not covered by 2.a through 2.e. Enclose an itemized
list explaining the need for each item and the basis
for the estimate.
3. Indirect Costs. Identify indirect cost rate(s) and
base(s) as approved by the cognizant Federal agency,
including the effective period of the rate. If
unapproved rates are used, explain why and include a
computational basis for the indirect expense pool and
corresponding allocation base for each rate.
4. Other Applicable Costs. Enter the total of any other
applicable costs not covered by instructions 1 through
3. Enclose an itemized list explaining the need for
each item and the basis for the estimate.
5. Subtotal -- Estimated Costs. Enter the sum of items 1,
2.a through 2.f, 3, and 4.
6. Less Proposed Cost Sharing (if any). Enter the amount
proposed, if any. If cost sharing is based on specific
cost items, identify each item and amount in enclosures.
7. Carryover Funds (if any). Enter the dollar amount of
any funds that are expected to be available for
carryover from the prior budget period.
8. Total Estimated Costs. Enter the total after
subtracting items 6 and 7 from item 5.
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PERSONNEL AND COMPUTER USAGE SUMMARY
Provide for each year of proposed effort.
TITLE OF INVESTIGATION:
PRINCIPAL INVESTIGATOR AND INSTITUTION:
SUMMARY OF PERSONNEL: (Nearest 0.1 work years (WY), nearest $K)
1. Senior personnel (list name(s))..................... WY____ $________
2. Postdoctorate associate (list name(s)).............. WY____ $________
3. Student(s) (give number)............................ WY____ $________
4. Technical support staff (give number)............... WY____ $________
5. Other............................................... WY____ $________
6. TOTAL............................................... WY____ $________
EXPECTED SUPER COMPUTER USAGE: (include endorsements as appropriate)
1. Location and type for each computer ________________________________
2. Estimated number of Computing Units (CU's) for each facility ________
3. If GSFC/NASA Center for Computational Sciences (NCCS) is
proposed for use, list estimated number of CU's: ________
(enter also on page C-2)
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CURRENT AND PENDING RESEARCH SUPPORT
1. For the Principal Investigator and each Co-Investigator,
provide separately for each category A and B the following
information:
- Source of support
- Project title and sentence abstract
- Award amount
- Period covered by award
- Work-year commitment of the proposed
Investigator.
CATEGORY A. Currently supported research project(s)
that will be active during FY 1996
(October 1, 1995, through September 30, 1996).
CATEGORY B. Research project(s) for which support
is(are) pending (including renewal applications
as well as this proposal).
2. List the name of any other funding sponsor to which this
proposal has been or will be contemporaneously submitted,
including relevant dates.
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Certification Regarding
Debarment, Suspension, and Other Responsibility Matters
Primary Covered Transactions
This certification is required by the regulations
implementing Executive Order 12549, Debarment and
Suspension, 34 CFR Part 85, Section 85.510, Participant's
responsibilities. The regulations were published as Part
VII of the May 26, 1988 Federal Register (pages
19160-19211). Copies of the regulations may be obtained by
contacting the U. S. Department of Education, Grants and
Contracts Service, 400 Maryland Avenue, S. W. (Room 3633 GSA
Regional Office Building No. 3), Washington, D. C. 20202-
4725, telephone (202) 732-2505.
(1) The prospective primary participant certifies to the
best of its knowledge and belief, that it and its
principals:
(a) Are not presently debarred, suspended, proposed
for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal
department or agency;
(b) Have not within a three-year period preceding this
proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a
criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal,
State or local) transaction or contract under a public
transaction; violation of Federal or State antitrust
statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records,
making false statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise
criminally or civilly charged by a governmental entity
(Federal, State or local) with commission of any of the
offenses enumerated in paragraph (1)(b) of this
certification; and
(d) Have not within a three-year period preceding this
application/proposal had one or more public
transactions (Federal, State or local) terminated for
cause or default.
(2) Where the prospective primary participant is unable
to certify to any of the statements in this
certification, such prospective participant shall attach
an explanation to this proposal.
__________________________________________________________
Institution Principal Investigator
___________________________________________________________
Name and Title of Authorized Representative
___________________________________________________________
Signature Date
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Certification Regarding Drug-Free Workplace Requirements
Grantees Other Than Individuals
This certification is required by the regulations
implementing the Drug-Free Workplace Act of 1988, 34 CFR
Part 85, Subpart F. The regulations, published in the
January 31, 1989 Federal Register, require certification by
grantees, prior to award, that they will maintain a drug-
free workplace. The certification set out below is a
material representation of fact upon which reliance will be
placed when the agency determines to award the grant. False
certification or violation of the certification shall be
grounds for suspension of payments, suspension or
termination of grants, or government wide suspension or
debarment (see 34 CFR Part 85, Sections 85.615 and 85.620).
The grantee certifies that it will provide a drug-free
workplace by:
(a) Publishing a statement notifying employees that
the unlawful manufacture, distribution, dispensing,
possession or use of a controlled substance is
prohibited in the grantee's workplace and specifying
the actions that will be taken against employees for
violation of such prohibition;
(b) Establishing a drug-free awareness program to
inform employees about-
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug-free
workplace;
(3) Any available drug counseling, rehabilitation,
and employee assistance programs; and
(4) The penalties that may be imposed upon
employees for drug abuse violations occurring in the
workplace;
(c) Making it a requirement that each employee to be
engaged in the performance of the grant be given a copy
of the statement required by paragraph (a);
(d) Notifying the employee in the statement required
by paragraph (a) that, as a condition of employment
under the grant, the employee will-
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug
statute conviction for a violation occurring in the
workplace no later than five days after such
conviction;
(e) Notifying the agency within ten days after
receiving notice under subparagraph (d)(2) from an
employee or otherwise receiving actual notice of such
conviction;
(f) Taking one of the following actions, within 30
days of receiving notice under subparagraph (d)(2),
with respect to any employee who is so convicted-
(1) Taking appropriate personnel action against
such an employee, up to and including termination;
or
(2) Requiring such employee to participate
satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by
a Federal, State, or local health, law enforcement,
or other appropriate agency;
(g) Making a good faith effort to continue to maintain
a drug-free workplace through implementation of
paragraphs (a), (b), (c), (d), (e) and (f).
___________________________________________________________
Institution Principal Investigator
___________________________________________________________
Name and Title of Authorized Representative
___________________________________________________________
Signature Date
C-9
Certification Regarding Lobbying
As required by S1352 Title 31 of the U.S. Code for persons
entering into a grant or cooperative agreement over
$100,000, the applicant certifies that:
(a) No Federal appropriated funds have been paid or will be
paid by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, in connection
with making of any Federal grant, the entering into of any
cooperative, and the extension, continuation, renewal,
amendment, or modification of any Federal grant or
cooperative agreement;
(b) If any funds other than Federal appropriated funds have
been paid or will be paid to any person for influencing or
attempting an officer or employee of any agency, Member of
Congress, an or an employee of a Member of Congress in
connection with this Federal grant or cooperative agreement,
the undersigned shall complete Standard Form -LLL,
"Disclosure Form to Report Lobbying," in accordance with its
instructions.
(c) The undersigned shall require that the language of this
certification be included in the award documents for all
subawards at all tiers (including subgrants, contracts under
grants and cooperative agreements, and subcontracts), and
that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon
which reliance was placed when this transaction was made or
entered into. Submission of this certification is a
prerequisite for making or entering into this transaction
imposed by S1352, title 31, U.S. Code. Any person who fails
to file the required certification shall be subject to a
civil penalty of not less that $10,000 and not more than
$100,000 for each such failure.
__________________________________________________________________
Organization Name AO or NRA Number and Name
__________________________________________________________________
Printed Name and Title of Authorized Representative
__________________________________________________________________
Signature Date
__________________________________________________________________
Printed Principal Investigator Name Proposal Title
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