1. Agency/Sponsor Deadline: Indicate official deadline specified by the agency or sponsor and whether the document must be postmarked or received by that date. If there is no official deadline enter none.
    
2. Submission Instructions: Indicate how the document should be submitted. A completed airbill or prepaid stamp must be attached overnight delivery service. If additional information is requested, please enter in the space provided (Electronic Submission System - please enter the System by which it must be submitted, Will Pick Up - please enter the name & phone number of the pick up contact, Fax To: - the name, phone if available & fax of the person to send the information). If there is not sufficient room in the space, please hand write on the t-form after printing.
    
3. UW Contact and Phone: Someone who is knowledgeable, available and able to answer questions regarding the information pertaining to this form and the materials routed with it.
    
4. Number of Copies to Agency/Sponsor: Indicate the total number of copies required by the Agency or Sponsor. In addition, one copy must be provided to the Dean and RSP.
    
5. Agency/Sponsor: Provide agency or sponsor's complete name and street address to ensure accurate mailing of the proposal or award document. Overnight Delivery addresses cannot contain P. O. Boxes or P. O. Box Zip Codes. If the funding is passing through the listed sponsor from another agency, please list that "Prime" source of funding on the line provided.
    
6. Investigator(s): There can be only one Principal Investigator (PI), other key personnel may be listed as co-investigators. The selections for appointment type are for the PI only. If the "Other Appointment" box is checked and permanent PI status has not been granted by the Dean of the Graduate School, contact your departmental office. The Dean's office representative is responsible for approving any "Other Appointment" personnel for PI status by initialing the line provided.
    
7. a. Project Administration: Identify the campus (Unit), school/college (Div), and department (Dept) responsible for administering the project. The activity code [Act(s)] should be the numeric designation matching the primary purpose(s) of the project: & - Farm Operations; 1 - Institutional Support; 2 - Instruction; 4 - Research; 5 - Public Service; 6 -     Academic Support; 7 - Physical Plant; 8 - Auxiliary Enterprise; 9 - Financial Aid. Indicate the name of department administering the project.
   
   B. Secondary Spending Edits: Identify additional campuses, schools/colleges, or departments that will have authority to spend project funds. Note the requirements for cross department or division projects.
    
8. Project Title: Provide the title of the proposal or award. Indicate specific program, if applicable.
    
9. Proposals: Check the appropriate box(es):
   • New (original submission of this project to this sponsor);
   • Renewal (requested support beyond that previously committed by sponsor);
   • Continuation (a request for funds previously committed by sponsor);
   • Supplement (a request for additional funds for current budget/project period);
   • Revision (a modification of a previously submitted proposal) provide the PALS number of the project being revised.
   Enter total requests (direct and indirect) and the beginning and ending dates of the entire project.
   Awards: Check the appropriate box:
   • New Account (establishment of a new account number);
   • Add to Account (add funds to an existing account);
   • Other Account (non-monetary agreements such as transfer of materials, technology, proprietary information, and equipment loans).
   Provide amount of award and beginning and ending dates of the entire project. If the award includes payment, indicate amount enclosed and check number(s).

Required Clearances:

10. If the project involves any of the listed materials, approval by the Biological Safety Committee is required. Attach a copy of most recent notice of committee approval of this project. For more information call the Biological Safety Office (263-2037). Additional information is available on the Biological Safety Office web site.
     
11. If the project involves the use of humans in any way as research subjects, or involves use of human tissues, a UW-Madison IRB must approve or exempt the research or defer review to another IRB. Attach a copy of the most recent committee notice concerning this project if available at the time of proposal. Additional information is available on the Human Research Protections Program web site.
     
12. If the project involves either living or dead vertebrate animals, an approved "Animal Care and Use Protocol" must be on file with the Research Animal Resources Center (RARC). Attach a copy of most recent notice of committee approval of this project. For more information call RARC (262-1238). Additional information is available on the RARC web site.
     
13. If the project requires any new, additional, remodeled, rental, or reassignment of space, contact your Dean's office.
     
14. If the project or its products will transcend the physical boundaries of the immediate experimental area, or have significant potential environmental consequences, contact the Biological Safety Office (263-2037) prior to preparing an environmental assessment.

Required Signatures:

Principal Investigator: In signing, the principal investigator certifies that she/he has identified all space, personnel, equipment and budgetary needs associated with the proposal or award, and that the proposal or award and this form are accurate and complete in all regards, including technical matters, adherence to sponsor's guidelines, budget and required clearances.

Department Chair(s) and Dean(s): Significant differences among schools and colleges make it inappropriate for campus administration to assign primary and secondary responsibility to departments and deans' offices. Signatures by the department chair and dean or their authorized representatives in the Administering Unit confirm that the proposal or award and this form have been reviewed and found to be accurate and complete, including required clearances, budget and commitments involving space, faculty/staff time and matching funds. Please note the requirements for projects that cross departments or divisions.

Research and Sponsored Programs (Graduate School): The signature of an authorized individual within the Graduate School is required when the proposal or award requires an exception to a UW-Madison policy (e.g. proposed indirect cost rate less than the standard federal rates or a previously approved non-federal rate).

Instructions for Addendum to Extramural Support Transmittal Form (Page 2)

Intellectual Property Agreement

The Board of Regents of the University of Wisconsin System is the legal recipient of all grants and contracts from extramural sponsors. The Board and its officers, employees and agents are legally responsible for complying with all terms and conditions of the award including those involving copyrights, patents, licensing and proprietary information. In signing an "Extramural Support Transmittal Form," a Principal Investigator (PI) or other University employee agrees to comply with all terms and conditions of the proposal and any resulting agreement or award.

The PI further agrees to accept the responsibility for assuring that all other project participants (except clerical and nontechnical) also agree to the terms and conditions of any resulting agreement or award. The PI may modify the signature block on the top portion of the "Addendum to Extramural Support Transmittal Form" or the same version appearing in the University's "Intellectual Property Policies and Procedures for University Research" dated January 1998 to obtain the signatures of project staff.

Investigator's Outside Activities Reporting

Investigators (PIs, co-investigators, key staff) are required to have filed an Outside Activities Report by April 30 of each year. Proposals to a federal agency will not leave campus until the investigators have filed the report. Potential conflicts do not have to be resolved at the time of proposal submission, but must be resolved before the University can accept an award.

If the outside activities of the investigators (or their immediate families) have changed since they filed their annual report, an updated report must be filed.

NIH Certification

The National Institutes of Health requires all Principal Investigators to have a written certification on file indicating their concurrence with regulations regarding scientific conduct. See Notice OD-06-054. All NIH applications must include all PIs' signature(s) before leaving campus.

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